背景:宫颈硬膜外血肿(CEH)是一种罕见但具有潜在破坏性的疾病,以颈椎硬膜外腔内的血液积聚为特征,导致脊髓压迫(PerronAD,HuffJS。脊髓疾病。在:马克思JA,etal.编辑。罗森急诊医学:概念与临床实践。第8版费城:桑德斯;2013年。pp.1419-27.);(RaasckK,哈比斯AA,AoudeA,SimoesL,巴罗斯F,自发性脊髓硬膜外血肿的治疗:病例系列和文献复习。脊髓Ser病例。2017;3:16043。https://doi.org/10.1038/scsandc.2016.43.);(山本亮M,伊藤H,ShimuzuK,WakabayashiH,大山.2例表现为左侧偏瘫并需手术引流的颈部硬膜外血肿。Cureus.2022年;14(4):e23915。https://doi.org/10.7759/cureus.23915.).虽然创伤和医源性原因是有据可查的,归因于颈部劳损和针灸的病例并不常见。(RaasckK,哈比斯AA,AoudeA,SimoesL,巴罗斯F,自发性脊髓硬膜外血肿的治疗:病例系列和文献复习。脊髓Ser病例。2017;3:16043。https://doi.org/10.1038/scsandc.2016.43.);(白石S,GotoI,KuroiwaY,NishioS,脊髓损伤是针灸的并发症。神经病学。1979;29(8):1188-90。https://doi.org/10.1212/wnl.29.8.1188.)在这里,我们介绍了2例继发于这些异常病因的CEH。两种情况都强调了考虑CEH的不常见原因以确保早期识别和及时治疗的重要性。
方法:病例1是一名81岁的女性,在颈部拉伤后跌倒,出现左侧偏瘫和感觉异常。颈椎磁共振成像(MRI)显示左侧C3-C7硬膜外血肿伴严重脊髓压迫。在案例2中,一位35岁的绅士在接受针灸后仅10分钟就突然出现四肢麻木和无力。MRI显示在C2-C4水平处有硬膜外血肿。两名患者均接受了立即手术减压,并且恢复明显。
结论:尽管CEH是罕见的,可能是神经外科急症.医师必须认识到与CEH相关的多种病因以及早期识别和立即治疗的必要性。
BACKGROUND: Cervical epidural hematoma (CEH) is a rare but potentially devastating condition, characterized by the accumulation of blood within the epidural space of the cervical spine, leading to spinal cord compression (Perron AD, Huff JS. Spinal cord disorders. In: Marx JA, et al. editors. Rosen\'s emergency medicine: concepts and clinical practice. 8th ed. Philadelphia: Saunders; 2013. pp. 1419-27.); (Raasck K, Habis AA, Aoude A, Simoes L, Barros F, Reindl R. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases. 2017;3:16043. https://doi.org/10.1038/scsandc.2016.43 .); (Ryo Yamamoto M, Ito H, Shimuzu K, Wakabayashi H, Oyama. Two cases of cervical epidural hematoma presenting with left-sided hemiplegia and requiring surgical drainage. Cureus. 2022;14(4):e23915. https://doi.org/10.7759/cureus.23915 .). While trauma and iatrogenic causes are well-documented, cases attributed to neck strain and acupuncture are uncommon. (Raasck K, Habis AA, Aoude A, Simoes L, Barros F, Reindl R. Spontaneous spinal epidural hematoma management: a case series and literature review. Spinal Cord Ser Cases. 2017;3:16043. https://doi.org/10.1038/scsandc.2016.43 .); (Shiraishi S, Goto I, Kuroiwa Y, Nishio S, Kinoshita K. Spinal cord injury as a complication of an acupuncture. Neurology. 1979;29(8):1188-90. https://doi.org/10.1212/wnl.29.8.1188 .) Here, we present two cases of CEH secondary to these unusual aetiologies. Both cases highlight the importance of considering uncommon causes of CEH to ensure early recognition and prompt treatment.
METHODS: Case 1 is an 81-year-old lady who presented with left hemiparesis and paraesthesia following a fall with neck strain. Magnetic resonance imaging (MRI) of cervical spine revealed left C3-C7 epidural haematoma with severe cord compression. In Case 2, a 35-year-old gentleman experienced sudden onset numbness and weakness in all limbs just 10 minutes after receiving acupuncture. MRI showed an epidural hematoma at the C2-C4 levels. Both patients underwent immediate surgical
decompression and had significant recovery.
CONCLUSIONS: Although CEH is a rare occurrence, it can potentially be a neurosurgical emergency. Physicians must remain cognizant of the diverse aetiologies associated with CEH and the necessity for early recognition and immediate treatment.