PDF(Pubmed)
Abstract：
Spinal cord compression is a neurosurgical emergency. Symptoms of this disorder are highlighted as back pain, ambulatory difficulties, and bladder/bowel incontinence. Diagnostic imaging is not indicated in many circumstances of nonspecific back pain; however, the addition of neurologic deficits in the setting of back pain justifies radiologic imaging. Various pathologies can cause constriction of the spinal cord due to the delicate nature of spinal cord anatomy. Etiologies may include trauma, neoplasms, and infections. In this report, we present an unusual case of a 31-year-old male who presented to the emergency department with a history of chronic back pain accompanied by neurological deficits, ataxia, and bladder dysfunction. Contrast-enhanced MRI imaging heightened the suspicion of a neoplastic etiology; however, neuropathology revealed a non-neoplastic nature with abnormal lymphohistiocytic infiltrate suspicious for Langerhans cell histiocytosis or infectious etiology. A second opinion was provided by Mayo Clinic Laboratories, resulting in the definitive conclusion that the mass was non-neoplastic and tested negative for SD1a and Langerhin, biomarkers used to diagnose Langerhans cell histiocytosis. This unusual non-neoplastic lesion exemplifies one of many diverse and multifaceted pathologies that can precipitate spinal cord compression. Additionally, these findings underscore the importance of considering both neoplastic and non-neoplastic causes in the differential diagnosis of spinal cord compression, thereby enhancing clinical vigilance and improving patient outcomes for underlying spinal conditions.
摘要：
脊髓压迫是神经外科急症。这种疾病的症状表现为背痛，流动困难，和膀胱/肠失禁。在许多非特异性背痛的情况下，不需要诊断成像;然而，在背痛的背景下增加神经系统缺陷证明放射学成像是合理的。由于脊髓解剖结构的微妙性质,各种病理可引起脊髓的收缩。病因可能包括外伤,肿瘤，和感染。在这份报告中,我们介绍了一个不寻常的病例，一个31岁的男性，他到急诊科就诊，有慢性背痛并伴有神经功能缺损的病史，共济失调,和膀胱功能障碍。对比增强MRI成像增强了对肿瘤病因的怀疑；然而，神经病理学显示非肿瘤性，异常淋巴组织细胞浸润，可疑为朗格汉斯细胞组织细胞增生症或感染性病因。梅奥诊所实验室提供了第二种意见，得出明确的结论，即肿块是非肿瘤性的，并且对SD1a和Langerhin测试为阴性，用于诊断朗格汉斯细胞组织细胞增生症的生物标志物。这种不寻常的非肿瘤性病变例示了可以导致脊髓压迫的许多不同和多方面的病变之一。此外,这些发现强调了在脊髓压迫的鉴别诊断中同时考虑肿瘤和非肿瘤原因的重要性。从而提高临床警惕性并改善患者对潜在脊柱疾病的预后。
