自发性脊髓硬膜外血肿的临床特征

Clinical features of spontaneous spinal epidural hematoma

目的对自发性脊髓硬膜外血肿的临床表现、影像学特点和病因进行总结。方法回顾4例经MRI证实的脊髓硬膜外血肿患者的资料,其中2例进行了脊髓硬膜外血肿清除术和病理学检查。结果4例患者均为急性起病,伴明显的胸背部疼痛,截瘫和尿潴留等脊髓受压的症状和体征。腰穿脑脊液检查结果正常。急性期MRI检查均可见受压节段脊髓硬膜外呈条形或梭形异常信号影,T1W等信号,T2W稍高信号,高信号中间杂小斑片状低信号。病理学结果为1例肉芽肿合并血肿,1例血管畸形合并血肿。2例外科手术的患者术后神经功能迅速恢复,2周后出院。未手术患者3～4周后出院。结论胸背部剧烈疼痛、单侧和双下肢截瘫、尿便障碍、影像学改变是诊断自发性脊髓硬膜外血肿的主要依据。脑脊液正常对诊断常有帮助。手术治疗可缩短病程和减少复发,也是病因检查的最有效方法。

Objective To investigate and summarize the etiopathogenisis, clinical symptoms and imaging features of spontaneous spinal epidural hematoma （SSEH）. Methods Four cases with MRI-diagnosed SSEH were retrospectively studied, among which two underwent spinal epidural hematoma removal and pathological examinations. Results The four cases all presented acute onset, accompanied with apparent pain in the chest-back region and symptoms and signs of spinal cord compression, such as paraplegia and urinary retention. The examination of their cerebrospinal fluid （CSF） via lumbar puncture was normal. MRI during the acute stage showed abnormal bar-like of fusiform signal intensity in the compressed spinal epidural segment. The signal intensity of the SSEH was isointense on T1-weighted images and slightly hyperintense on T2-weighted images with small heterogeneous patchy hypointensity. Pathological examinations found that one case was granuloma with hematoma and the other case was vascular malformations with hematoma. The neurological function of the 2 cases undergoing spinal epidural hematoma removal improved rapidly and they were discharged two weeks later, while others without operations were discharged three to four weeks later. Conclusion Pain in the chest-back region, paralysis of either or both lower extremities, disturbances of urine and stool, and imaging changes are the mainstays for the diagnosis of SSEH. Normal CSF may often be helpful for the diagnosis. Operations may shorten the course of the disease and reduce recurrence, which is also one of the most effective means to confirm the etiopathogenisis.