肩頸疼痛爲起始症狀表現之自發性脊椎硬腦膜外出血：病例報告

Spontaneous Spinal Epidural Hemorrhage with Shoulder and Neck Pain as Initial Presentation: A Case Report

10.6315/2008.36(4)07

郭酉民(Yu-Min Kuo)；李偉強(Wai-Keung Lee)；廖正智(Cheng-Chih Liao)；陳立蓉(Li-Rong Chen)

自發性脊椎硬腦膜外出血 ； 核磁共振 ； 復健 ； spontaneous spinal epidural hemorrhage ； magnetic resonance imaging ； rehabilitation

台灣復健醫學雜誌

36卷4期（2008 / 12 / 01）

251 - 257

繁體中文

自發性脊椎硬腦膜外出血(spontaneous spinal epidural hemorrhage)是非常罕見的疾病，一年的發生率約百萬分之一，同時也是須緊急處理的疾病。臨床上若未立即手術治療，預後會不好，甚至死亡的機率很高。脊椎硬腦膜外出血初期症狀爲頸部、胸部、背部疼痛，由於不易與其他常見頸部痛疾病鑑別診斷。在臨床上以核磁共振用於診斷脊椎硬腦膜外出血的敏感性很高。本病例報告一名22歲男性，開始症狀爲左肩膀與左側頸部酸痛，經過9天後，左下肢麻木且出現兩下肢無力的症狀，經核磁共振顯示在頸椎第5節至胸椎第一節脊椎硬腦膜外的後面位置，出現不正常的訊號顯示(signal intensity)。經緊急開刀後，病理組織診斷爲硬腦膜外血塊。手術中因爲找不到脊椎硬腦膜外出血的明確原因，故診斷爲自發性脊椎硬腦膜外出血。病人在復健過程中，經過肌力訓練，平衡訓練，行走訓練與日常生活訓練後，肌力漸漸恢復，行走能力逐漸正常，日常生活功能也逐漸恢復至獨立自主。 本文報告一個罕見的自發性脊椎硬腦膜外出血病例，並回顧文獻及討論其診斷、致病機轉、治療與預後，以提供臨床醫療人員作爲參考。

Spontaneous spinal epidural hemorrhage is a very rare disease, with an annual incidence estimated at one per million. Emergency surgery is indicated for a good prognosis, without which the death rate would be higher. Although the initial symptoms of cervical, thoracic, and back pain make it difficult to differentiate spontaneous spinal epidural hemorrhage from other common disease with similar symptoms, magnetic resonance imaging (MRI) is a highly sensitive diagnostic method. We report the case of a 22-year-old male patient who initially complained of pain over the left shoulder and left cervical area. After nine days, numbness was noted in his left lower leg, and both lower legs became weaker. MRI showed an abnormal signal intensity in the posterior region from the fifth cervical cord to the first thoracic cord. Because no definite etiology was found, spontaneous spinal epidural hemorrhage was suspected, and this diagnosis was confirmed by pathologic findings after surgery. The postsurgical rehabilitation training program included muscle strengthening, balance, ambulation, and activities of daily living (ADL). The patient recovered muscle function gradually and was eventually able to walk independently without a device. This report provides a review of the literature and discussion of the diagnosis, pathology, treatment, and prognosis of this disorder.