脊髄下端部梗塞の4例

Infarction of the Distal End of the Spinal Cord. Report of 4 Cases

　脊髄下端部梗塞を4例経験した．平均年齢は59歳で，発症時の麻痺はFrankel分類でそれぞれD，C，C，C，最終観察時にはE，D，C，Dであった．初期診断は胸椎椎間板ヘルニア，腰部脊柱管狭窄症，大腿動脈血栓症，腰椎椎間板ヘルニアであった．脊髄梗塞は発症早期における確定診断が困難であることに加えて脊髄下端部梗塞は髄節症状が主体で索路症候が捉えられにくい．確定診断に至るまでに複数回のMRIを必要とした．脊髄下端部梗塞は症状とは無関係の画像所見から誤診に至らないよう注意を要する．

　We report 4 cases of infarction of the distal end of the spinal cord. The average age of the patients was 59 years old. Paralysis according to Frankel's classification at the onset of symptoms was D, C, C, and C respectively, and it was E, D, C, and D at the time of observation, the most recent follow-up examination. The initial diagnosis was thoracic intervertebral disc herniation, lumbar canal stenosis, femoral arterial thrombosis, and lumbar intervertebral disc herniation, respectively. Diagnosis of spinal cord infarction is generally difficult, and diagnosis of infarction of the distal end is even more difficult. Because of frequent lack of long-tract signs, a second MRI examination was necessary to make a definitive diagnosis in our patient. When diagnosing infarction of the distal end of the spinal cord should be taken not to misdiagnose it based on misleading imaging findings that are unrelated to the true pathology.