椎管内阻滞严重神经并发症
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CASE
42 Y,M,173 cm,72 kg,开腹胆囊切除术
硬膜外麻醉(T7–T8),右腿短暂刺痛
2% 利多卡因(5 ml + 15 ml),T4
手术顺利,术后拔除硬膜外导管
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P5:右腿麻木、无力(2/5),累及左腿(4/5);深反射亢进;巴彬斯基征阳性;尿失禁和便秘;左腿位置觉受损
CT、MRI、运动诱发电位检查
脊髓炎(地塞米松、γ-球蛋白)
CASE
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M2:症状无改善
MRI :T2 信号像( T6 - T7 高信号损害); T1信号像( T6 - T7 等信号损害);增强 MRI:髓内环形增强。
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CASE
Figure 1 A) Sagittal T2-weighted MRI image of the thoracic spine shows a hyperintense lesion expanding the cord at the T6-7 spinal level. B) Sagittal T1-weighted MRI image of the thoracic spine shows an isointense lesion expanding the cord at the T6-7 spinal level. C) Coronal T1-weighted MRI shows a ring-like enhancing intramedullary lesion (16 × 7 × 6 mm) with gadolinium.
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CASE
脑脊液检查及培养
结核菌素试验、胸片
脊髓梗死、髓内炎性肉芽肿、髓内占位
地塞米松、抗病毒、康复训练
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CASE
M3:神经功能突然恶化,感觉损害平面至 T5,右下肢肌力( 0/5 ),左下肢肌力( 2/5 )
MRI:髓内损害扩大
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CASE
Figure 2 A) Sagittal T2-weighted MRI image of the thoracic spine at the time of neurologic deterioration shows an increase in the size of the lesion. B) Coronal T1-weighted MRI shows an enlarged ring-like enhancing intramedullary lesion (40 × 10 × 7 mm) with gadolinium.
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急诊手术治疗
术后病理报告
CASE
Figure 3 Histological examination showing epithelioid cells, lymphocytes, and Langerhans giant cells indicative of tuberculoma (hematoxylin-eosin, original magnification ×10).
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CASE
持续 6 月抗结核(利福平、异烟肼和吡嗪酰***)
Y:运动、感觉功能改善,辅助步行;可自主控制排尿
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