スポーツダイビングによる脊髄型減圧症の1例

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A woman in her early 30s suffered from paraparesis with bilateral lower leg weakness and sensory disturbance a few hours after scuba diving to a depth of 40m. Neurological examination revealed pyramidal tract signs of the lower legs, mild muscle weakness, mild sensory disturbance below Th6, severe disturbance of position sensation in the lower legs, and vesicorectal dysfunction. She was unable to stand due to severe ataxia in the truncus and lower legs. After administering 13 sessions of hyperbaric oxygen therapy and intravenous injections of sodium methylprednisolone succinate in 2 days and edaravone for 2 weeks, her lower leg muscle power recovered to the normal level; however, due to ataxia, she was still unable to stand and walk. An MRI of the spine revealed abnormal signals in the intramedullary lesion from C4 to Th6 that spread to the dorsal column of the spinal cord. Three months later, the lesion decreased in size; however, some parts of the lesion remained at the dorsal column. A study of the somatosensory evoked potentials of the bilateral posterior tibial nerves showed that the P36 signal was absent on the 9^<th> day. Six weeks from the accident, P36 appeared with a prolonged latency and small amplitude. The patient was diagnosed with spinal ataxia. Although we expected that the prognosis might be poor with regard to her ambulatory function, 5 months after rehabilitation admission, her ambulatory ability almost fully recovered. However, slight ataxia and severe vesicorectal dysfunction persisted.
2006-07-18

スポーツダイビングによる脊髄型減圧症の1例

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