Sphincter Disturbance as the Initial Presentation of Acute Lymphoblastic Leukemia：A Case Report

以括約肌失調為起始表現之急性淋巴球性白血病：病例報告

洪禎雯(Jen-Wen Hung) ； 郭景元(Ching-Yuan Kuo) ； 梁秋萍(Chau-Peng Leong)

《中華民國復健醫學會雜誌》 27卷1期 (1999/03) Pp. 31-36

摘要

根據研究，發生在兒童之系統性惡性腫瘤中，最易侵犯神經系統的是急性淋巴球白血病。但急性淋巴球白血病以侵犯腦部及軟腦膜為主，較少影響脊髓及神經根，且中樞神經系統症狀的出現多發生在診斷出白血病的同時或以後之治療過程中，很少以此為起始表現。而以侵犯脊髓圓錐及其附近之神經根為起始之表現，則更少見。
本例是一16歲男孩，過去沒有白血病病史，於八十六年七、八月間出現嚴重背痛、生殖器處疼痛及括約肌失調的現象，最後合併雙下肢肌力漸減至步行困難。經一系列的檢查，最後由骨髓及腦脊髓液檢查証實為急性淋巴球性白血病併腦脊髓膜侵犯，以臨床症狀、理學檢查、肌電圖及尿路動力學各項結果推論，其起始之表現應是影響到脊髓圓錐及其附近神經根的結果。這在急性淋巴球白血病是較少見的。
由於此病經化學治療及放射治療反應良好，早期發現可減少其神經系統方面的後遺症，如本例在接受治療後兩週其症狀有十分明顯的改善。現提出此病例，並討論其侵犯中樞神經系統的路徑、鑑別診斷、治療方法等，以供大家參考。

關鍵字

括約肌失調 ； 起始表現 ； 急性淋巴球性白血病

並列摘要

Acute leukemia is the most common malignancy involving the central nervous system (CNS) among childhood. Neurological manifestations of leukemia frequently occur during the course of acute leukemia. However, it is rarely an isolated feature as the initial presentation of leukemia. The spinal cord and spinal roots are less frequently involved than other CNS regions. It is very rare to have neurologic involvement of conus medullaris as an initial presentation of acute lymphoblastic leukemia (ALL).
This case was a 16 year-old boy who suffered from sever back pain and disturbance of sphincter function before the diagnosis of ALL. The diagnosis of acute lymphoblastic leukemia (L3, Burkitt’s type) with leptomeningeal involvement was confirmed based on the bone marrow and cerebral spinal fluid examinations.
Now that management of leukemia is possible and even is successful with chemotherapy and radiotherapy, it is more important to recognize and alleviate any neurologic morbidity of these patients.
We presented this case with an attempt to cover the pathogenesis, differential diagnosis, treatment of ALL involving spinal cord and to call the attention to such case.

並列關鍵字

sphincter disturbance ； initial presentation ； acute lymphoblastic leukemia