自發性脊髓硬膜外血腫：病例報告

Spontaneous Spinal Epidural Hematoma: A Case Report

林修平(Shiou-Ping Lin) ； 朱大同(Da-Tong Ju) ； 蔡高宗(Kao-Chung Tsai) ； 謝明福(Ming-Fu Hsieh)

《台灣復健醫學雜誌》 33卷2期 (2005/06) Pp. 103-110

https://doi.org/10.6315/2005.33(2)06

摘要

自發性脊髓硬膜外血腫(spontaneous spinal epidural hematoma)是指非外傷性、意外、醫源性（如腰椎穿刺、脊椎麻醉）等原因所產生的脊髓硬膜外血腫。較嚴格之定義則需更進一步排除使用抗凝血劑、凝血病變，潛在性腫瘤或血管異常的病例。過去文獻報告曾提出自發性脊髓外血腫在脊髓硬膜外空間佔據病灶疾病中佔0.3%-0.9%，它是一種罕見脊椎急症且具診斷之挑戰性。在此我們報告一位21歲之年輕男性，因突發頸部疼痛延伸至雙肩及雙側下肢肢體無力併解尿困難而被送至急診，經頸椎核磁共振造影檢查發現頸脊髓硬膜外出血，患者接受緊急減壓手術及復健治療後，除仍有輕微之神經性膀胱外，其他神經功能均逐漸恢復正常。因係罕見病例且早期診治對病患日後功能的恢復影響很大，希望藉此病例報告及回顧相關文獻資料，做為臨床醫師診療頸背部疼痛患者之參考。

關鍵字

自發性脊髓硬膜外血腫 ； 減壓手術 ； 椎板切除術

並列摘要

Spontaneous spinal epidural hematoma (SSEH) refers to a spinal epidural hematoma that is not secondary to trauma, incidental, and iatrogenic (such as lumbar puncture or spinal anesthesia). SSEH represents 0.3%-0.9% of spinal epidural space-occupying lesions. It is a rare spinal emergency, yet a diagnostic challenge. We reported a 21-year-old young male who was admitted with sudden weakness of bilateral lower limbs and difficulty in urination. The cervical epidural hematoma was noted by spinal magnetic resonance imaging examination. After emergency decompressive operation and postoperative rehabilitation, the patient had gradual improvement of neurological function, yet the presence of slight neurogenic bladder dysfunction. Early diagnosis and treatment are very important for patient's functional recovery. Because this disease is rare, we report this SSEH case to remind our medical colleage while managing neck or back pain patients.

並列關鍵字

spontaneous spinal epidural hematoma ； decompression operation ； laminectomy