馬尾神経神経鞘腫と誤診した腰椎椎間板ヘルニア

A Case of Lumbar Herniated Disc Simulating Neuronoma of the Cauda Equina

I．はじめに

　脊髄腫瘍と腰椎椎間板ヘルニアの鑑別診断は，その病歴，神経症状，補助検査所見から，多くの場合容易である^19）．

　しかし腰椎椎間板ヘルニアと診断されたもので，手術時に初めて腫瘍が確認された症例は少なくなく^{4,12,18,21）}Mayo clinicの報告に例をとっても，514個の脊椎管内腫瘍のうち29例（5.6％）の術前診断は腰椎椎間板ヘルニアであった^13）．

A 34-year-old female suffered from low back pain withincomplete recovery for ten years. Six months prior toadmission, she began to complain of a paresthesia in theleft leg, the radiating pain into the left femoral region andthe gait disturbance.

On admission, decreased PTR on the left side and sensorydeficits of varying intensities involving L, to ², level onboth sides were noted, suggesting a space occupying lesionof the cauda equina.