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病例漫谈102:胸椎间盘突出诱发的布朗-塞卡尔综合征 [复制链接]

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A healthy 36-year-old manpresented to the emergency department with a painless and progressive leftfootdrop, numbness in the right leg and urinary hesitancy for 10 days.Physical examination showed the following signs affecting the patient’s left side:weakness in all myotomes of the lower extremity (most prominent in the distalmuscle groups), abnormal proprioception of the toes, brisk reflexes and anupgoing plantar reflex. Sensation to sharp touch and temperature was diminishedin the dermatomes on the right side caudal to T10. The clinical patternindicated incomplete hemisection of the spinal cord, classically associatedwith Charles Edouard Brown-Séquard, who first described the noweponymous syndrome in the mid-19th century.

一名36岁健康男性患者向急诊科陈述存在无痛性左足下垂,右腿麻木和排尿不畅,这些症状已持续10天。体格检查显示以下这些症状正在影响患者左侧身体:下肢肌节无力(远端肌群最为突出),脚趾本体感觉异常,腱反射活跃。右侧尾椎至T10的皮区触觉和对侧温度的敏感度下降。这些临床症状表明脊髓存在不完全损伤,这是与查尔斯-爱德华-布朗-塞卡尔有关的典型症状。正是他在19世纪中叶首次描述了现在命名为布朗-塞卡尔的综合征。


Magnetic resonance imaging (MRI)showed herniation of the intervertebral disc between T8 and T9, suspected to beintradural, with hemi-spinal cord compression on the left side (Figures 1A and 1 B). Computed tomography showed calcification of the herniated disc(Figure 1C).

磁共振成像(MRI)显示T8和T9之间存在椎间盘突出,疑似在硬膜内,左侧半脊髓同时受到压迫(图1 A和1 B)。CT检查显示钙化的椎间盘突出(图1 C)。


In Brown-Séquard syndrome, thecontralateral loss of sensation to sharp touch and temperature is attributableto the compression of the neurons in the spinothalamic tract, decussating nearwhere they enter the spinal cord. Disruption of this ascending tract leads tosensory loss opposite to the compression. The ipsilateral weakness and loss ofproprioception result from compression of the lateral corticospinal tract andposterior columns, respectively. These neurons decussate in the brainstemmedulla; therefore, functional loss is ipsilateral to the lesion (Figure 1 D).These hallmark findings are associated with penetrating injuries to the spinalcord, compressive extramedullary spinal tumours, hematomas, herniated intervertebraldiscs and numerous other causes. Prompt surgical intervention is oftenrequired; therefore, expedited MRI of the spine should be performed for anypatient presenting with Brown-Séquard syndrome. This patient, withoutpredisposing conditions for disc herniation, underwent urgent posteriorsurgical decompression and resection of the intradural disc, which requireddivision of the T9 nerve root on the left side, and instrumented fusion.Postoperatively, the patient regained ambulatory function and only experiencesthe expected left-sided sensory deficit at the T9 level.

在布朗-塞卡尔综合征中,触觉和对侧温度的敏感度相应丧失是由于脊髓丘脑束神经元受压迫,这些神经元交叉进入脊髓。上述这些神经束的断裂导致了知觉丧失以阻止神经受压。同侧无力和本体感觉丧失的病因分别为皮质脊髓侧束受压和后部脊柱受压。这些神经元在脑干延髓处交叉;因此,功能性损失与病变部位同侧(图1 D)。这些标志性的发现与脊髓穿透性损伤,脊髓外肿瘤压迫,血肿,椎间盘突出和其他许多原因有关。及时的手术干预通常是必须的;因此,布朗-塞卡尔综合征患者必须尽快接受脊柱MRI检查。该患者没有椎间盘突出症患病倾向,接受了紧急的后路减压术及硬膜内椎间盘切除术,这需要切除左侧T9神经根处并进行融合固定术。术后,患者恢复行走能力,仅在T9段出现了预期的左侧知觉丧失。


Figure1: Magnetic resonance imaging scans (T 2-weighted) of the spine in(A) sagittal and (B) axial view, showing a large, herniatedintervertebral disc between T8 and T9 (white arrow) with spinal cordcompression. (C) Computed tomography scan in sagittal view, showingcalcification of the herniated disc (white arrow). (D) Illustration of anaxial view of the spine between T8 and T9, showing the compressive effects ofthe disc herniation on the sensory and motor pathways of the spinal cord on theleft side.

图1:脊椎磁共振成像扫描(T2加权)的矢状图(a)和轴向图(b)显示T8和T9之间(见白色箭头)存在一个较大的椎间盘突出,并伴随脊髓受压。矢状面CT扫描(c)显示钙化的椎间盘突出(见白色箭头)。T8和T9脊柱之间的轴向视图(d)显示椎间盘突出对左侧脊髓的感觉和运动路径造成的压迫性影响。


由Medicool医库软件 王露黔 编译

原文来自 Brown-Séquard syndrome from herniation of a thoracic disc

最后编辑Wang Luqian 最后编辑于 2016-07-22 16:44:33
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