脊髓萎縮症之診斷及治療︰一病例報告

The Diagnosis and Treatment of a spinal Cord Atrophy: Case Report

陳允宜(Yun-Yee Chen) ； 單定一(Din-E Shan) ； 鄭明德(Min-The Cheng) ； 徐道昌(Tao-Chang Hsu)

《中華民國復健醫學會雜誌》 20期 (1992/12) Pp. 199-203

摘要

本案例為脊髓萎縮症，病人為一名64歲男性榮民，在40年前發生突發性下肢麻木及漸進性走路位置感覺異常，病症一直到二年後才趨於穩定，本次症狀再度復發而住院，理學檢查顯示下肢的位置感覺及胸脊髓第十節以下的振動感覺有缺陷，核磁共振顯示胸脊椎第十節至第十二節的黃韌帶肥厚，因而壓迫脊髓，因所造成第二胸椎至第十胸椎的脊髓萎縮。復建則靠加強肌肉力量，促進平衡及加強視覺的輔助而行走。

並列摘要

This is a case of a 64-year-old male with difficulty in ambulation for 40 years. Physical examination revealed a defect in vibration and positional sense over the lower extremities. Muscle power of the upper extremities was normal. The lower extremities could still resist force, but there was a little atrophic change in the quadriceps muscle and weakness over the iliopsoas muscle.
Laboratory data were all negative, including CSF, routine blood, urine and stool specimens. However, MRI revealed hypertrophy of the ligamentum flavum with spinal cord compression. CT with myelogram revealed T2-T10 spinal cord atrophy. SSEP revealed T-myelopathy. EMG revealed upper motor neuron disease.
The etiology is related to spinal cord compression over T10-T12 by the ligamentum flavum. Wallerian degeneration developed, so spinal cord atrophy (posterior column) was found mainly over T2-T10. Surgery is mainly applied only in the acute stage, but this is a chronic case of posterior column ataxia including position sense, tactile and kinaesthesia defect.
The protocol for rehabilitation in this type of case involvse training the patient to ambulate with greater reliance on his sense of sight and to be aware of the position of his feet. Training also aims at improving the patient's sense of space. In addition, balance training and ambulation assistance devices should be emphasized.

並列關鍵字

spinal cord atrophy ； ossification and hypertrophy of ligamentum flavum