Early Rehabilitation Intervention for Idiopathic Transverse Myelitis

橫斷性脊髓炎為一少見疾病，其特徵是脊髓有局部發炎，臨床症狀為快速進展的運動、感覺和自主神經缺失，通常可清楚界定出感覺缺失的部位，患者臨床表現為下肢無力、麻木感及不同程度的膀胱功能障礙，須與多發性硬化症做鑑別診斷，其症狀為肢體無力，感覺麻木，深層肌腱反射增加。另外，不同的病灶位置會有不同的症狀，包括視力缺損，複視，頭暈，臉麻，構音困難，排尿困難。本文報告一位47歲女性，一開始的症狀是突然急速的身體麻木伴隨著下肢無力和排尿困難。沒有外傷，感染，發燒，皮膚關節紅腫，或特殊旅遊史。神經學檢查發現下肢特別無力，從第四胸椎以下有明顯麻木感，深層肌腱反射增加，合併雙側腳掌伸展反射。入院當天的磁振造影沒有不正常的發現，三天後第二次磁振造影在T2W1發現第二胸椎到第七胸椎有訊號增強的病灶。因為脊髓病灶是單一且連續的，而且視覺誘發電位(Visual evoked potential (VEP))是正常的，患者的最後診斷是橫斷性脊髓炎。患者經過積極復健後下肢肌力增加，可自行走路，排尿功能從無法自解，改善到自行排尿。持續追蹤三年後病人可獨立處理日常生活不需他人照顧。透過此罕見病例，我們必須謹記早期積極復健可減少併發症，使患者得儘早回復日常生活獨立。

關鍵字

橫斷性脊髓炎；多發性硬化症；復健

並列摘要

Transverse myelitis is a rare disease. It is characterized by focal inflammation within the spinal cord, which develops symptoms of neurological dysfunction of motor, sensory, and autonomic nerves. There is often a clearly defined border of sensory dysfunction. The clinical symptoms usually include lower limb weakness, bladder dysfunction, and numbness. Transverse myelitis and multiple sclerosis have many common symptoms. We reported a 47-year-old female whose initial manifestations were a sudden onset of numbness, lower limb weakness, and voiding dysfunction. Neurological examination showed decreased muscle power of the bilateral lower limbs. Pain sensation was decreased below the T4 level. A second spinal magnetic resonance imaging (MRI) three days after admission showed a long and continuous segment of hyperintense lesions in the spinal cord from T2 to T7 level on T2WI. Based on the fact that the lesion of spinal MRI was continuous and as a result of fact that the visual evoked potential was normal, transverse myelitis was impressed. After early rehabilitation intervention, the muscle power of her lower limbs was significantly improved; she was able to walk independently and her voiding function was regained. After following up for three years, she had recovered well and can deal with activities of daily living in an independent manner. Based on the above, we suggest that early rehabilitation of idiopathic transverse myelitis patients is important.

並列關鍵字

transverse myelitis ； multiple sclerosis ； rehabilitation

國際替代計量

Early Rehabilitation Intervention for Idiopathic Transverse Myelitis

未授權

主題瀏覽