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医学影像服务中心国内唯一分系统影像病例库上线哦。小编
本期病例选自AJNRCaseoftheWeek
ShengZhuang,MD;WeiweiZhu,MD,PhDDepartmentofNeurosurgeryTheFirstAffiliatedHospitalofSoochowUniversitySuzhou,JiangsuProvince,China
双语学影像授权发送
病史A25-year-oldwomanwithsudden-onsetweaknessoflowerlimbs,urinaryincontinence,andsensorydisturbancefromthenipplelinedownward,8hoursafternormalvaginaldelivery
25岁女性，顺产后8小时，突发下肢无力，小便失禁，乳头水平以下感觉异常。
图例SagittalT1WI(A),T2WI(B),andaxialT2WI(D)revealsaright-lateral,focal,crescenticepiduralmassattheT1-T2vertebralsegments,predominantlyhyperintenseonT1WI,withcentralhypointensityonT2WI.ThespinalcordatthesamelevelshowsslighthyperintensityonT2WI,suggestiveoffocaledema.Oncontrast-enhancedT1WI(C),thelesiondisplaysperipheralenhancement.
矢状位T1WI、T2WI及横断位T2WI示：T1-T2水平椎管内偏右侧、硬膜外可见一局限性新月形肿块，T1WI呈高信号，T2WI可见中央低信号；相应水平脊髓内见稍长T2信号影，提示局限性脊髓水肿。
增强后，T1WI矢状位扫描，病灶可见周边强化。
SpontaneousSpinalEpiduralHematoma(SSEH)
inthePostpartumPeriod
产后自发性椎管内硬膜外血肿
背景AmongtherecognizedconditionsthatcouldpredisposeonetoSSEH,pregnancyaccountsfor1%,andothersincludeanticoagulanttherapy,vascularmalformations,hemophilia,andvasculitis.
根据影像资料，考虑诊断为自发性椎管内硬膜外血肿（SSEH）。1%左右的患者由妊娠诱发发病，其他原因包括抗凝治疗、血管畸形、血友病、血管炎症等。
SSEHinpregnancyorthepostpartumperiodisbelievedtobeassociatedwithruptureofprimitivevalvelessepiduralveinsowingtoelevatedthoracic,abdominal,andpelvicpressureduringorafterpregnancy.Hyperdynamiccirculationafteruterinecontraction,hormonaleffectsonvessels,andhypercoagulablestatearealsoamongtheproposedfactors.
妊娠或产后胸腔、腹腔、盆腔内压力增高引起硬膜外无瓣膜的静脉丛破裂，是妊娠或产后SSEH的主要发病原因。另外，子宫收缩引起的循环血量增加、激素刺激血管、血液易凝状态等也是可能的致病因素。
临床表现Sudden-onsetpaininthechest-backregion,limbweaknessandsensationdisturbance,paraplegia,urinaryretention,orBrown-Sequardsyndrome
SSEH的临床症状包括：胸背部突发疼痛、下肢无力、感觉异常、截瘫、尿潴留、脊髓半切综合征等。
影像诊断要点CT:Crescentichigh-intensitymasswithinthespinalepiduralspace
CT:椎管内硬膜外可见新月形高密度肿块
MRI:Acutestage—isointensityonT1WIandslighthyperintensityonT2WIwithheterogeneouspatchyhypointensity.HyperintensityonbothT1WIandTWI2canbeseeninthesubacutestage.Peripheralenhancementofthehematomaisthoughttoberelatedtoperipheralbloodsupplyandhyperemia.Theabsenceofflow-voidswithinorsurroundingthelesionmayhelptoexcludeanunderlyingarteriovenousmalformation,whichcanbefurtherconfirmedbyangiography.
MRI：急性期T1WI呈等信号；T2WI呈不均匀稍高信号，内可见斑片状低信号。亚急性期，T1WI和T2WI均呈高信号。增强扫描的周边强化可能与病灶周边血供及充血有关。病灶内或病灶周围未见流空血管影，可以排除血管畸形的可能性，这也可以通过血管造影进一步检查证实。
鉴别诊断Spinalarteriovenousmalformation
椎管内动静脉畸形
Spinalsubduralhematoma
椎管内硬膜下血肿
Epiduralabscess
硬膜外脓肿
Metastasesorlymphoma
转移瘤或淋巴瘤
治疗