脊柱颌骨病导致严重的多器官损伤。磁共振成像(MRI)和血清学有助于诊断,并评估疾病的严重程度和程度。然而,神经通路的生理学无法证实。电诊断可能在证明中枢和周围神经通路的功能以及疾病的预后评估中起作用。
一名18岁男子表现为神经根疼痛和下肢快速进行性无力,导致三天内截瘫.临床评估和实验室检查,包括血清学,MRI,和电诊断,被执行了。
调查显示L1截瘫伴尿潴留。T型脊柱系列MRI显示沿胸椎下段脊髓纵向T2低信号病变,表现为症状发作时脊髓水肿的径迹样出血,T11-T12脊髓结节状增强,以及在第一次MRI后两个月的MRI中增强和聚集马尾神经根。脑脊液和血清中Gnathostoma抗体阳性。给予静脉注射糖皮质激素和口服阿苯达唑。治疗后三个月,症状在感觉上有所改善,但运动功能没有改善。进行电诊断。在双侧胫骨和腓骨运动神经传导研究(NCS)中,振幅非常小,没有反应。双侧腓肠感觉NCS正常。胫骨体感诱发电位(SSEP)和运动诱发电位(MEP)均未记录。在发病后8个月没有观察到患者的临床状态的进一步改善。
电生理研究结果证明了脊髓和周围神经在脊髓颌骨畸形患者中的功能。MRI和电生理发现之间存在相关性,证实了该疾病的病理生理学。SSEP和MEP反应的缺乏与神经根瘤引起的神经根性脊髓炎的不良神经系统预后相关。感染。
Spinal
gnathostomiasis results in serious multiorgan impairments. Magnetic resonance imaging (MRI) and serology help in diagnosis, and assessing the severity and extent of the disease. However, the physiology of neural pathway could not be demonstrated. Electrodiagnosis may have a role in demonstrating the functions of the central and peripheral neural pathways and prognostic assessment of the disease.
An 18-year-old man presented with radicular pain and rapid progressive weakness of lower extremities, leading to paraplegia in three days. A clinical evaluation and laboratory tests, including serology, MRI, and electrodiagnosis, were performed.
The investigation showed L1 paraplegia with urinary retention. The serial MRI of T-spine showed longitudinal T2 hypointense lesion along the lower thoracic spinal cord, representing track-like hemorrhage with spinal cord edema at the onset of symptoms, nodular enhancement of T11-T12 spinal cord, and enhancing and clumping of cauda equina nerve roots in the MRI at two months after the first MRI. The CSF and serum for Gnathostoma antibody were positive. Intravenous corticosteroid and oral albendazole were given. Three months after treatment, the symptoms improved in sensation but not in motor function. The electrodiagnosis was performed. There were very small amplitudes and no response in bilateral tibial and peroneal motor nerve conduction studies (NCS) respectively. The bilateral sural sensory NCS were normal. Neither tibial somato-sensory evoke potentials (SSEP) nor motor evoke potential (MEP) was recorded. No further improvement of patient’s clinical status at eight months after onset was observed.
Electrophysiological findings demonstrated the function of spinal cord and peripheral nerves in the patient with spinal
gnathostomiasis. There were correlations between MRI and electrophysiological findings that confirmed pathophysiology of the disease. Absence of SSEP and MEP response correlated with poor neurological outcomes in radiculomyelitis caused by Gnathostoma spp. infection.