A Case of Acute Nontraumatic Cervical Myelopathy Presenting as Acute Ipsilateral Hypoesthetic Hemiparesis

一病例報告以急性感覺減弱性半側偏癱為表徵之急性非外傷性頸部脊髓病變

陳建志(Jiann-Jy Chen) ； 陳登郎(Dem-Lion Chen) ； 林巧容(Chiao-Jung Lin)

《童綜合醫學雜誌》 9卷2期 (2015/12) Pp. 100-105

摘要

一40歲男性，因急性左側肢體無力及感覺減弱急診於本院。理學檢查顯示左半側偏輕癱，該側對刺痛及輕觸等感覺減弱，腦部電腦斷層無異常發現，臆斷為急性腦小孔狀腦梗塞，故給予抗血小板劑治療，並進行年輕型中風風險因子探查。然而，住院後左側肢體癱瘓加重，腦部磁振造影無異常發現，但頸部磁振造影顯示頸部椎間盤脫出，合併頸部脊髓壓迫。遂更改治療策略為頸圈固定及靜脈注射類固醇，神外建議手術治療。頸部椎間盤脫出併發急性非外傷性脊髓病變在初期會十分類似急性小孔狀腦梗塞，縱然很少見，但仍要提高警覺，畢竟治療策略與腦中風截然不同。

關鍵字

頸部椎間盤脫出 ； 急性非外傷性脊髓病變 ； 感覺減弱性半癱 ； 年輕型腦中風 ； 分離性感覺缺失

並列摘要

A 40-year-old man presented with sudden onset of left limb weakness and numbness upon getting up. Neurological examination revealed left hemiparesis with ipsilateral decreases in pain and touch sensation. Brain computed tomography was unremarkable. Initial impression was acute lacunar infarction, so oral antiplatelet therapy and work-up for stroke in the young were started. However, there was progression of hemiparesis. Brain magnetic resonance imaging (MRI) was unremarkable, but cervical spine MRI demonstrated intervertebral disc herniation with cord compression. Oral antiplatelet therapy was discontinued; the patient was placed on cervical orthosis, and intravenous corticosteroid was administered. Eventually, he underwent surgical decompression. The muscle strength recovered fully and the sensory defects disappeared one week after surgery. Cervical disc herniation with acute nontraumatic myelopathy may mimic acute lacunar infarction at initial presentation. Although rare, this differential diagnosis should be kept in mind considering that its management entirely differs from that of stroke.

並列關鍵字

cervical disc herniation ； acute non-traumatic myelopathy ； hypoesthetic hemiparesis ； young stroke ； dissociated hypoesthesia/anesthesia