胸椎间盘突出致脊髓半切综合征1例

A case of brown-séquard syndrome caused by thoracic disc herniation

脊髓半切综合征(BSS)是指由外部压迫或内部病变引起的脊髓不完全损伤,导致具有特征性的临床表现及体征,表现为损伤平面以下同侧肢体的上运动神经元性瘫痪,深感觉及精细触觉障碍,血管舒缩功能障碍,损伤平面以下对侧肢体的痛温觉消失,肌力不受影响。引起该综合征的原因很多,但因椎间盘突出导致的相对较少。本文介绍1例63岁女性患者,临床表现为急性起病的BSS,完善颅脑及脊髓磁共振等检查后明确了病因,考虑因椎间盘突出并不适当弯腰导致胸段脊髓损伤,在激素、七叶皂苷钠等药物治疗、手术解除压迫及术后康复治疗下,患者恢复正常。通过本病例进一步加深了对BSS的了解,肯定了MRI在明确诊断中发挥的作用,巩固了激素在脊髓损伤中的治疗地位,同时也提示对需要手术治疗的患者尽快手术解除压迫的必要性。

Brown-séquard syndrome(BSS)refers to incomplete spinal cord injury caused by external compression or internal lesions,resulting in characteristic clinical manifestations and signs.It is manifested as upper motor neuron paralysis of the ipsilateral limb below the injury level,deep sensation and fine touch disorders,vasomotor dysfunction,disappearance of pain and temperature sensation in the contralateral limb below the injury level,and unaffected muscle strength.There are many reasons for this syndrome,but relatively few are caused by intervertebral disc herniation.This article introduces a 63-year-old female patient who presented with acute onset of BSS in clinical practice.After completing brain and spinal cord magnetic resonance imaging examinations,the cause was determined.It was considered that thoracic spinal cord injury was caused by improper bending due to intervertebral disc herniation.Under the treatment of hormones,sodium aescinate and other medications,surgical decompression,and postoperative rehabilitation,the patient recovered to a normal state.Through this case,we have further deepened our understanding of the BSS,affirmed the role of MRI in clear diagnosis,consolidated the role of hormones in the treatment of spinal cord injury,and also realized the necessity of surgical decompression for patients who need surgical treatm ent as soon as possible.