细菌性脊髓髓内脓肿和马尾神经炎经保守治疗消退1例。

Q4 Medicine
Fujio Umehara
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引用次数: 0

摘要

病人是一位70多岁的老妇人。1个月前腰痛、左下肢疼痛逐渐加重,出现尿潴留及双侧下肢瘫痪,住院。双下肢肌肉无力,感觉减退,双下肢疼痛(以右侧为主),双下肢肌腱反射丧失。MRI显示严重腰椎畸形,脊髓圆锥肿胀,环形造影剂效果,马尾神经造影剂效果。脊髓圆锥弥散加权图像显示多灶性高信号。脑脊液显示271个细胞/mm3(72%多形核细胞),蛋白356‍mg/dl,糖15‍mg/dl,细菌培养阴性。怀疑细菌性髓内脊髓脓肿和马尾神经炎,开始静脉注射头孢曲松/万古霉素,并口服MNZ。此后,双下肢肌肉无力和感觉障碍逐渐改善,1个月后患者可以用拐杖行走。脑脊液及MRI表现逐渐恢复正常。诊断为细菌性脊髓髓内脓肿及马尾神经炎,经保守治疗后好转。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
[A case of bacterial intramedullary spinal cord abscess and cauda equina neuritis that resolved with conservative treatment].

The patient is a woman in her 70s. Low back pain and left lower limb pain gradually worsened since 1 month ago, urinary retention and bilateral lower limb paralysis appeared and she was admitted to our department. Muscle weakness in both lower limbs, hypoesthesia and pain in both lower limbs predominantly in the right side, and loss of tendon reflexes in both lower limbs were observed. MRI showed severe lumbar deformity as well as swelling of the spinal conus medullaris, ring-shaped contrast effect, and contrast effect of the cauda equina nerve. Diffusion-weighted images of the spinal conus showed multifocal high signal. Cerebrospinal fluid showed 271 cells/mm3 (72% polymorphonuclear cells), 356 ‍mg/dl protein, 15 ‍mg/dl sugar, and negative bacterial culture. Suspecting bacterial intramedullary spinal abscess and cauda equina neuritis, she was started on intravenous Ceftriaxone (CTRX)/ Vancomycin (VCM) and oral MNZ. Thereafter, muscle weakness and sensory disturbance in both lower limbs gradually improved, and the patient was able to walk with a cane one month later. Cerebrospinal fluid and MRI findings gradually normalized. The diagnosis of bacterial intramedullary spinal cord abscess and cauda equina neuritis was made, which improved with conservative treatment.

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来源期刊
Clinical Neurology
Clinical Neurology Medicine-Neurology (clinical)
CiteScore
0.30
自引率
0.00%
发文量
147
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