共查询到18条相似文献,搜索用时 78 毫秒
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临床资料例1,男性,42岁,突然背部剧痛、双下肢瘫痪18小时入院。无外伤及剧烈活动史.既往有高血压病史10年余。查体;血压26川护。,水冲脉,体温正常.项神经检查无异常,须无抵抗及压痛,两肺呼吸音清,心率72次/分,心尖呈抬举样待动,心界向左下扩大.心关可闻及Smlll,向左腋下传到,左】.、肋间可闻及吸气样Dsm,向心尖传导,脊柱无畸形.压痛不明显,膀联区充盈。双上肢肌力正常,双下肢肌力右互级,左11级,肌张力正常.T4平面以下感觉减退.以双下肢明显,腹墨反射.提单反射消失,膝反射、跟位反射减弱,踝阵李(+),巴… 相似文献
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例1,女,70岁,1998年4月7日下午无任何诱因,突感枕颈部刺痛并向双肩部放射,半小时后转为持续性钝痛,约3h后出现四肢麻木,无力,呼吸困难,6h后入我院。查体:神清,呼吸浅快,轻度紫绀,四肢肌力Ⅲ级,躯干和四肢痛温觉迟钝,小便不能自解。急诊行颈椎MRI检查示C2,3膜外背侧可见一长约2-5cm的棱形占位。T1呈等信号,T2呈高信号,MRI增强阴性,考虑自发性硬脊膜外血肿(SSEH)。于发病后9h在全麻下行C2,3椎板切除血肿清除脊髓减压术,术中见C2,3硬脊膜外背侧偏左有暗红凝血块,量约5m… 相似文献
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目的分析自发性椎管内硬膜外血肿(SSEH)的影像学特征及临床治疗效果。方法回顾性分析2008年6月—2018年9月泰州市人民医院脊柱外科收治的SSEH患者临床资料,分析其影像学表现。采用硬膜外脊髓压迫(ESCC)分级评估硬膜外占位对硬膜囊及脊髓的压迫程度,美国脊髓损伤协会(ASIA)分级评估神经功能,疼痛视觉模拟量表(VAS)评分评估疼痛情况。结果本研究共纳入12例患者,年龄25 ~ 74岁,中位年龄64.5岁。MRI显示SSEH大多呈梭形、椭圆形,且多位于脊髓侧后方或后方的硬膜外腔。血肿最多发于颈段(4例)或颈胸段(4例)。血肿累及1 ~ 4个节段,平均2.6个节段。T1WI MRI上7例表现为等信号,4例表现为高信号,1例表现为低信号;T2WI MRI上10例表现为高/混杂信号,2例表现为低信号。血肿压迫脊髓程度(ESCC分级)与患者神经功能损伤程度(AISA分级)密切相关(r=0.85,P 0.01)。7例患者行手术治疗,其中5例术后神经功能有所恢复,2例术前ASIA分级为A级的患者末次随访时仍为A级;5例采用非手术治疗,治疗后神经功能均有所恢复,VAS评分下降。结论 MRI是诊断SSEH的最佳检查方法。根据患者神经功能损伤及进展情形,可选择非手术治疗或尽早手术治疗。 相似文献
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自发性肾周血肿5例报告及文献复习 总被引:1,自引:0,他引:1
报告自发性肾周血肿5例,其病因为肾癌1例。双肾囊肿1例,慢性肾功能衰竭血液透析者1例,原因不明2例,除1例肾癌行根治性肾切除发生转移而死亡外,余4例经保守治疗均获成功。并复习文献就肾周血肿的诊断及治疗进行讨论,认为对原因不明者,应行CT密行随访;行肾切除术应采取谨慎态度。 相似文献
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BACKGROUND: Spontaneously occurring epidural hematomas for which no etiology is identified are rare phenomenon. These are often neurosurgical emergencies; therefore, prompt diagnosis and treatment are paramount. Because of the rarity of this condition, we have illustrated in this recent case its presentation, evaluation and management. METHODS: A 63-year-old male presented to our emergency room with right-sided hemiparesis and contralateral hypesthesia, consistent with a C5 Brown-Séquard syndrome. An initial evaluation for cerebral infarction was unremarkable, including a negative brain magnetic resonance image. Further imaging revealed a cervical epidural hematoma of unknown etiology. RESULTS: The patient underwent emergent laminectomy for decompression and evacuation of the hematoma within 24 hours of his presentation to the emergency room. The patient's symptoms improved remarkably after surgery and a 4-month follow-up imaging evaluation revealed no recurrence of his hematoma. CONCLUSION: This report highlights the various presentations, evaluation, and management options for this rare diagnosis. It emphasizes the necessity of prompt diagnosis for possible emergent intervention. 相似文献
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自发性颈椎椎管内硬膜外血肿1例报告 总被引:2,自引:0,他引:2
自发性椎管内硬膜外血肿(spontaneous spinal epidural hematoma,SSEH)在临床上较少见,起病隐匿,进展迅速,常常因为认识不足导致误诊而错过最佳治疗时机,影响预后,甚至出现永久性神经功能损伤。我们收治1例自发性颈椎硬膜外血肿患者,报道如下。 相似文献
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Context
Spontaneous spinal epidural hematoma (SSEH) is a rare idiopathic condition that leads to acute onset of neurological deficits, which if not recognized early can have catastrophic consequences. The definition and pathophysiology of this condition remain controversial. High index of suspicion followed by T2-weighted gradient echo sequences are particularly useful in early diagnosis. Management consists of prompt surgical decompression of the hematoma though a recent trend is toward non-surgical treatment.Findings
A 70-year-old man presented with acute onset neck pain with a radicular component and rapidly progressive quadriparesis. Magnetic resonance imaging revealed a posteriorly located cervical extradural hematoma with cord compression that was promptly evacuated. Functional recovery to near normal function occurred within 24 hours of surgery.Conclusion
SSEH in its true idiopathic form is a rare pathologic entity. Because of the high risk of poor outcome without treatment, SSEH should be a diagnostic possibility when presentation is even slightly suggestive. Prompt surgical evacuation of the hematoma leads to a favorable neurological outcome, whereas delay in treatment can be disastrous. The role of conservative management needs to be proven and should be tailored on an individual basis. 相似文献15.
The authors report a case of a 71-year-old man, who had thoracic pain, flaccid paraplegia, sensory loss below the level of Th10, and disturbance of the sphincter control. CT myelography disclosed an isodensity epidural mass lesion from Th10 to L2, which compressed the spinal cord ventrolaterally. Laminectomy was immediately performed and an epidural hematoma was verified. The literatures of spinal epidural hematoma located in the thoraco-lumber region were reviewed. 相似文献
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自发性脊髓硬膜外和硬膜下血肿 总被引:3,自引:0,他引:3
目的 探讨自发性脊髓硬膜外血肿(SSEH)及硬膜下血肿(SSSH)的病因、临床特点、诊治方法及预后相关因素。方法 自1995~2002年收治的4例SSEH及2例SSSH患者.均在静息或轻微活动后发病,发病前均无感染或服药史,其中1例63岁患者诉有高血压病史.1例65岁患者入院检查后发现患有Ⅱ型精尿病.余均否认患有其他疾病。所有患者均表现为突发性的颈、肩、胸、背部疼痛,数分钟到数小时内出现肢体运动、感觉障碍、大小便障碍及潴留,5例患者有抻经根放射痛症状.有3例行腰穿,压力无明显增高.均行手术治疗.手术距发病时间10~16d.平均12.5d,手术均在局麻下进行.4例SSEH患者行患部全椎板切除血肿清除术.2例SSSH患者行全椎板切除并硬静膜切开血肿清除,硬脊膜修补术。结果 均经MR检查、手术及病理证实。MRI显示椎管后方或后外方占位性病变,T1加权能特征性地反映血肿随时间发生的信号变化而最有价值.T22加权可很好地判断血肿的位置,患者预后与术前的神经功能状态及发病至手术的时间密切相关,本组患者随访6~18个月,平均10个月.6例患者除大、小便功能有不同程度的改善外.5例患者肢体的运动、感觉功能无明显恢复,1例SSSH患者感觉消失平面下降,右上肢肌力较前增强,结论 自发性脊髓硬膜外及硬膜下血肿是一种少见病,MRI是其首选的检查方法,应当注意的是早期诊断并及时手术是治疗SSEH和SSSH.防止永久性神经功能障碍的关健。 相似文献
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BACKGROUND: Traumatic clival epidural hematoma is an extremely rare reported entity. CASE DESCRIPTION: We describe the case of a 26-year-old woman involved in a car accident who presented with a Glasgow Coma Scale score of 13, bilateral abducens palsy, bilateral numbness on the mandibular territory of the trigeminal nerve, and left hypoglossal palsy. Radiological examinations revealed a clival epidural hematoma. The patient was managed conservatively, with clinical improvement of her neurological condition. This is the first traumatic clival epidural hematoma reported in an adult. From a review of the literature, we found only 8 cases. CONCLUSION: The pathophysiology of these hematomas is still a subject of debate; occipitoatlantoaxial ligamentous instability may play a role in it. In one third of the cases, bilateral cranial nerve palsies were associated. Apparently, they have a benign outcome. 相似文献