关键词: lipomyelomeningocele spinal bifida spinal dysraphism tethered cord syndrome urinary incontinence lipomyelomeningocele spinal bifida spinal dysraphism tethered cord syndrome urinary incontinence

来  源:   DOI:10.7759/cureus.22590   PDF(Pubmed)

Abstract:
The objective is to describe a rare case of lumbar lipomyelomeningocele presenting as progressive urinary incontinence. Lipomyelomeningocele is a type of closed spinal dysraphism typically presenting as a lipomatous mass contiguous with a neural defect above the gluteal crease. Tethered cord syndrome is defined as symptoms and signs caused by excessive spinal cord tension from an abnormally low conus medullaris, with an abnormally thick filum terminale attached to the lower sacral region. A 19-year-old male with no remarkable medical history presented with low back pain and urinary incontinence for the past one year. On physical exam patient had normal motor strength, sensory testing to all modalities was intact. The rectal tone was normal, and no saddle anesthesia was noted. MRI lumbar spine revealed lumbar lipomyelomeningocele with associated tethered cord syndrome. The patient underwent tethered cord release surgery with lipoma excision. Pathology of the soft tissue showed fibrovascular tissue and mature adipose tissue consistent with lipoma. The majority of cases of tethered cord syndrome are related to spinal dysraphism, a rare pediatric syndrome. It is potentially treatable if caught early, and MRI can help with an accurate diagnosis of the condition. Older adults are more likely to present with urological and neurological complaints. Surgical un-tethering is indicated in patients with progressive symptoms. In our case, the only presenting symptom was urinary incontinence, and the neurological exam was normal other than lower lumbar paraspinal tenderness.
摘要:
目的是描述一例罕见的表现为进行性尿失禁的腰椎膜膜膨出症。脂膜脊膜膨出是一种闭合性脊柱发育不良,通常表现为脂肪瘤状肿块,在臀裂上方有神经缺损。脊髓栓系综合征被定义为由异常低的脊髓圆锥引起的过度脊髓张力引起的症状和体征。末端有一个异常厚的丝附于下部骶骨区。一名19岁男性,无明显病史,过去一年出现腰背痛和尿失禁。在身体检查中,患者的运动强度正常,所有方式的感官测试都完好无损。直肠音正常,并且没有注意到鞍式麻醉。MRI显示腰椎脂肪膜脊膜膨出伴脊髓栓系综合征。患者接受了栓系脐带松解术和脂肪瘤切除术。软组织病理显示纤维血管组织和成熟脂肪组织符合脂肪瘤。大多数脊髓栓系综合征病例与脊髓发育不良有关,一种罕见的儿科综合症.如果及早发现,它可能是可以治疗的,MRI可以帮助准确诊断病情。老年人更容易出现泌尿系统和神经系统疾病。有进行性症状的患者需要进行手术解开。在我们的案例中,唯一的症状是尿失禁,除腰椎椎旁压痛外,神经系统检查正常。
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