血液透析患者に生じた脊髄硬膜外膿瘍の1自験例

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A 35-year-old female who had been undergoing hemodialysis for 8 years because of renal failure developed back pain and paraplegia. A neurological examination demonstrated complete paraplegia with sensory level at Th4, loss of position sense and areflexia of the legs, positive Babinski's sign, and atonic anal sphincter. Myelography via the lumbar route disclosed a complete block at Th4, with displacement of the cord to the right by an epidural mass lesion. Five days after the onset of.paraplegia, a Th3 through Th5 laminectomy was performed and an encapsulated abscess containing creamy pus was totally removed. The pathological diagnosis was non-specific abscess. On the 7th postoperative day, the sensory level started to drop down and within 3 weeks the patient was able to move her legs. Now, 8 months after surgery, she is able to walk with the help of a cane. Spinal epidural abscess is relatively rare. The authors describe its clinical manifestations and review the literature. Early diagnosis and prompt surgical decompression of the cord are considered essential to recovery from paraplegia. However, even delayed surgery may be successful, as shown in this case.
日本脳神経外科学会の論文
1988-08-15