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抄録:骨傷の明らかでない頚髄損傷で,受傷後数日から麻痺レベルが緩徐に上行した症例を経験した.症例は57歳,男性.5mの高さから転落し受傷.C6の不全麻痺,C7以下の完全麻痺を呈していた.骨傷はみられず,MRIでは脊髄に多椎間圧迫を認め,C5/6を中心にT2高信号領域を認めた.受傷後2日より麻痺レベルが上行しはじめ,受傷後11日目には自発呼吸が消失した.受傷後16日に頚部脊柱管拡大術を行い,自発呼吸の改善がみられた.本症例は多椎間圧迫による脊髄易損性に加え,受傷翌日より2日間著明な低血圧を起こしており,そのため脊髄血行障害が生じ麻痺が上行した可能性があると考えられた.
We report a cace of slowly progressive neurologic deterioration after cervical spinal cord injury without bony injury. A 57-year-old man fell from a height of 5meter. He developed C6 incompletely paralysis and complete paralysis below C7 with the injury. MRI revealed multiple cervical spinal canal stenosis and T2 high intensity area at the cord of C5/6 area. He was also suffering from low blood pressure for a couple of following days. The level of paralysis started to progress 2 days after injury. His automatic breathing was stopped at day 11. After cervical laminoplasty performed at day 16, the automatic breathing was recovered. Insufficiency of the spinal cord circulation with low blood pressure may cause the late onset of the neurologic deterioration.
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