- 期刊
Cervical myelopathy secondary to cervical disc protrusion in patient with dystonic cerebral palsy--A case report
張力異常型腦性麻痺患者伴隨頸部不正常動作之頸髓病變--病例報告
摘要
頸部有不自主運動的患者，發生頸椎神經根或脊髓壓迫病變過去僅有少數報告，主要發生在舞蹈型-張力異常型的腦性麻痺者。一般認為，長期過度的頸部動作易使頸椎提早退化，是造成神經壓迫的主要原因，但真正的致病機轉及其治療原則，則尚無定論。這裡，我們報告例罕見的頸部椎間盤凸出導致頸髓病變的病例。這病人是一位24歲的腦性麻痺男性患者，自幼即有頸部的張力異常動作，但日常生活可獨立。其臨床表徵包括頸部疼痛及漸進式的四肢無力，經核磁共振造影檢查發現在頸椎第三、四節之間椎間盤凸出並壓迫頸髓的情形。由於放射線檢查並無頸椎退化現象，故我們認為反覆性頸椎不自主運動可能造成其椎間盤凸出，而致頸髓病變，不一定源自傳統所認定之脊椎退化。患者接受頸椎間板術以解除脊髓壓迫症狀，手術後。有部分的功能復原。經過復健治療，雖可以穿戴兩側長腿支架，持助行器行走，但日常生活仍須協助。由於這種病例在臨床上並不多見，極易誤診而延誤治療導致病情惡化，因此建議臨床醫師如逢類似情形之病例應及早作核磁共振造影檢查以利早期作適當處置。
關鍵字
無資料並列摘要
Cervical myelopathy had been noted in patients with involuntary neck movement, especially in individuals with athetoid-dystonic cerebral palsy(CP). The excessive and repeated neck motions were considered to be responsible for the premature spondylosis, which might be the cause of myelopathy. The exact pathophysiology and managements were still controversial. Here we present a rare case who was a male patient with long-lasting dystonic neck movement developing cervical myelopathy due to protrusion of disc in his relatively young age. Magnetic resonance imaging (MRI) showed the protrusion of cervical disc at the level of C3-4, which was correlated well with his clinical symptoms. Anterior diskectomy and bony fusion were done for decompression. Halo-vest immobilization was applied to prevent the instability coming from dystonic neck movement after surgery. There was partial neurologic recovery after surgery. It is a rare clinical condition and may be easily overlooked. Therefore we recommended that MRI should be done as early as possible for cases with similar presentations, in order to establish an early correct diagnosis and early intervention.
延伸閱讀
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