대한영상의학회지 (Journal of the Korean Society of Radiology)

  • 제64권5호
  • /
  • Pages.423-428
  • /
  • 2011
  • /
  • 1738-2637(pISSN)
  • /
  • 2951-0805(eISSN)
대한영상의학회 (The Korean Society of Radiology)
권호 표지

말총증후군에서 허리 자기공명영상의 유용성

The Usefulness of Lumbar Spine MRI for Cauda Equina Syndrome

  • 문태용 (양산부산대학교병원 영상의학과) ;
  • 백승국 (양산부산대학교병원 영상의학과) ;
  • 이인숙 (부산대학교병원 영상의학과 및 부산대학교병원 의학연구소)
  • Moon, Tae-Yong (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University Hospital) ;
  • Baik, Seung-Kug (Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University Hospital) ;
  • Lee, In-Sook (Department of Radiology, Pusan National University and Pusan National University Hospital Medical Research Institute, Pusan National University Hospital)
  • 발행 : 2011.05.01
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 대소변 장애 증상을 가진 말총증후군의 치료를 위한 허리 자기공명영상의 유용성을 알아 보았다. 대상과 방법: 오줌보 근전도 검사로 배뇨 장애를 가진 말총증후군에서 허리 자기공명영상을 시행했던 환자 10명을 대상으로 하였다. 그 진단은 말총 유착거미막염 4예, 척수원뿔위축 3예, 허리척주관협착증 3예, 결핵연수막염 1예, 엉치뼈전이암 1예, 그리고 경질막동정맥샛길 1예였다. 결과: 척주관협착증 3예는 감압후궁절제술, 엉치뼈전이암 1예는 방사선조사, 결핵연수막염 1예는 항결핵제 투여, 경질막동정맥샛길 1예는 아교색전술, 말총 유착거미막염 1예는 항콜린 제재 및 스테로이드 요법으로 5일 이내부터 대소변 장애 증상이 호전되기 시작하였고, 나머지 4예는 허리복막지름술과 신경줄기세포이식술로 치료 계획을 세웠다. 결론: 배뇨장애를 가진 말총증후군 환자에서 허리 자기공명영상은 척주관내 원인질병을 규명하고 치료 계획을 설정 할 수 있는 검사 방법이었다.

Purpose: To understand the usefulness of the lumbar MRI studies to establish therapeutic plans for cauda equina syndrome (CES) including the management of rectal and bladder dysfunction symptoms. Materials and Methods: We retrospectively reviewed the lumbar MRI studies of 10 patients with CES. Their diagnoses included four adhesive arachnoiditis of cauda equina (CE), three conus medullaris atrophies, three spinal canal stenoses, one tuberculous leptomeningitis, one metastatic tumor on the sacral canal, and one dural arteriovenous fistula with venous congestion of the conus medullaris. Results: In 6 of the 10 total cases the symptoms of rectal and bladder dysfunction were resolved by decompression laminectomies (n=2), irradiation (n=1), glue embolization (n=1), anticholine and steroid infusion (n=1), and anti-tuberculous medication (n=1) within at least 5 days. The 4 other cases were settled by lumboperitoneal shunting and neural stem cell implants. Conclusion: The study results indicate that lumbar MRI is the modality of choice in search for the causative lesion and to subsequently set up the best therapeutic plans for patients with CES.

키워드

참고문헌

  1. Fraser S, Roberts L, Murphy E. Cauda equina syndrome: a literature review of its definition and clinical presentation. Arch Phys Med Rehabil 2009;90:1964-1968 https://doi.org/10.1016/j.apmr.2009.03.021
  2. Ba B, Wu H, Jia LS, Yuan W, Shi GD, Shi JG. Cauda equina syndrome: a review of clinical progress. Chin Med J 2009;122:1214-1222
  3. Kerslake RW, Mitchell LA, Worthington BS. Case report: CT and MRI of the cauda equina syndrome in ankylosing spondylitis. Clin Radiol 1992;45:134-136 https://doi.org/10.1016/S0009-9260(05)80071-6
  4. Kerslake RW, Mitchell LA, Worthington BS. Case report: CT and MRI of the cauda equina syndrome in ankylosing spondylitis. Clin Radiol 1992;45:134-136 https://doi.org/10.1016/S0009-9260(05)80071-6
  5. Bell DA, Collie D, Statham PF. Cauda equina syndrome: what is the correlation between clinical assessment and MRI scanning? Br J Neurosurg 2007;21:201-203 https://doi.org/10.1080/02688690701317144
  6. Tait MJ, Chelvarajah R, Garvan N, Bavetta S. Spontaneous hemorrhage of a spinal ependymoma: a rare cause of acute cauda equina syndrome. Spine 2004;29:E502-E505 https://doi.org/10.1097/01.brs.0000143663.27275.7f
  7. Kostuik JP, Harrington I, Alexander D, Rand W, Evans D. Cauda equina and lumbar disc herniation. J Bone Joint Surg Am 1986;68:386-391 https://doi.org/10.2106/00004623-198668030-00011
  8. Gleave JR, Macfarlane R. Cauda equina syndrome: what is the relationship between timing of surgery and outcome? Br J Neurosurg 2002;16:325-328 https://doi.org/10.1080/0268869021000032887
  9. Mangialardi R, Mastorillo G, Minoia L, Garofalo R, Conserva F, Solarino GB. Lumbar disc herniation and cauda equina syndrome: considerations on a pathology with different clinical manifestations. Chir Organi Mov 2002;87:35-42
  10. Storm PB, Chou D, Tamargo RJ. Lumbar spinal stenosis, cauda equina, and multiple lumbosacral radiculopathies. Phys Med Rehabil Clin North Am 2002;13:713-733 https://doi.org/10.1016/S1047-9651(02)00013-X
  11. Agur AMR, Lee MJ. Grant's atlas of anatomy, 9th Ed. Philadelphia: Williams & Wilkins, 1991:246-254
  12. Olcay L, Aribas BK, Gokce M. A patient with acute myeloblastic leukemia who presented with conus medullaris syndrome and reviewth conusliterature. J Pediatr Hematol Oncol 2009;31:440-447 https://doi.org/10.1097/MPH.0b013e31819ed24b
  13. Lamer AJ, Pall HS, Hockley AD. Arrested progression of cauda equina syndrome of ankylosing spondylitis after lumboperitoneal shunting. J Neurol Neurosurg Psychiatry 1966;61:115-116
  14. Spector LR, Madigan L, Rhyne A, Darden B, Kim D. Cauda equina syndrome. J Am Acad Orthop Surg 2008;16:471-479 https://doi.org/10.5435/00124635-200808000-00006
  15. Lee JW, Myung JS, Park KW, Teom JS, Kim KJ, Kim HJ, et al. Fluoroscopically guided caudal epidural steroid injection for management of degenerative lumbar spinal stenosis: short-term and long-term results. Skeletal Radiol 2010;39:691-699 https://doi.org/10.1007/s00256-009-0860-1
  16. McCarthy MJ, Aylott CE, Grevitt MP, Hegarty J. Cauda equina syndrome: factors affecting long-term functional and sphincteric outcome. Spine 2007;32:207-216 https://doi.org/10.1097/01.brs.0000251750.20508.84
  17. Jellema K, Tijssen CC, van Gijn J. Spinal dural arteriovenous fistulas: a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain 2006;129:3150-3164 https://doi.org/10.1093/brain/awl220
  18. Gupta RK, Gupta S, Kumar S, Kohli A, Misra UK, Gujral RB. MRI in intraspinal tuberculosis. Neuroradiology 1994;36:39-43 https://doi.org/10.1007/BF00599194
  19. Ruff CA, Fehlings MG. Neural stem cells in regenerative medicine: bridging the gap. Panminerva Med 2010;52:125-147