Unusual Causes of Paraplegia: Literature Review

非尋常病因之截癱：文獻回顧

陳承毅(Cheng-I Chen) ； 范洪春(Hueng-Chuen Fan) ； 吳坤霖(Kun-Lin Wu)

《童綜合醫學雜誌》 14卷1期 (2020/06) Pp. 5-12

https://doi.org/10.3966/207135922020061401002

摘要

Paraplegia refers to damage to the neurons in the thoracic, lumbar, or sacral segments of the spinal cord, resulting in an injury that is often associated with the loss of motor or sensory functions. In general, the function of the upper limbs is not affected, and the extent of damage to the lower body is determined by the location and level of the injury. Due to advancements in medical technology, a considerable proportion of paraplegic patients can resume independent functions of daily life and return to work or school, following proper treatment and rehabilitation. However, paraplegia is only a symptom, not a cause; therefore, the early diagnosis of paraplegia is of great importance. The causes associated with paraplegia are numerous, ranging from common trauma to rare infections, and the symptoms can vary. We discussed five uncommon paraplegia causes that have been cited in the literature, including spinal dural arteriovenous fistula, spontaneous spinal epidural hematoma, aortic dissection, decompression sickness, and spinal tuberculosis, and review the pathophysiology and clinical symptoms associated with each cause, as well as their treatment and prognosis. We hope to expand the range of possibilities for the differential diagnosis of paraplegia, to increase the likelihood of proper diagnoses and treatment at early stages.

關鍵字

paraplegia ； arteriovenous fistula ； spontaneous hematoma ； decompression ； aortic dissection ； spinal tuberculosis

並列摘要

截癱是指脊髓的胸、腰或薦段中神經元的傷害，導致運動或感覺功能的損傷或喪失。一般而言，上肢的功能不受到影響，而其下半身受損的程度則依據受傷的位置和範圍決定。以現今的醫療水平，截癱的病人在經過適當的治療與復健之後，仍有相當比例的患者能恢復生活獨立自主的功能，甚至重返工作崗位或學校進修。然而，截癱只是種表象而非病因，因此，早期的診斷顯得更重要。其造成的原因族繁不及備載，症狀也是各式各樣，從常見的創傷到少見的感染都有可能。本篇文章列舉了五個不常見的原因，包括脊髓硬脊膜動靜脈瘻管、自發性脊椎硬腦膜外血腫、主動脈剝離、潛水減壓症與脊椎結核病，並且從病例的呈現到簡單討論個別病因的病生理機轉、症狀和治療等，希望藉此使各位讀者在遇到截癱的病人時可以有更多的鑑別診斷，從而提早進行治療。

並列關鍵字

截癱 ； 動脈廔管 ； 硬脊膜外血腫 ； 主動脈剝離 ； 潛水減壓症 ； 脊椎結核病