{"created":"2023-06-19T10:29:33.224338+00:00","id":1661,"links":{},"metadata":{"_buckets":{"deposit":"847e8a21-2f51-4933-9b6f-c68ac7a2fb29"},"_deposit":{"created_by":31,"id":"1661","owners":[31],"pid":{"revision_id":0,"type":"depid","value":"1661"},"status":"published"},"_oai":{"id":"oai:kwmed.repo.nii.ac.jp:00001661","sets":["1709617079800:35:321:560"]},"author_link":["111214","111215","111216","111217","111218","111219"],"item_1694495855422":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_type":"VoR"}]},"item_3_biblio_info_12":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2014","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"108","bibliographicPageStart":"103","bibliographicVolumeNumber":"40","bibliographic_titles":[{"bibliographic_title":"川崎医学会誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Kawasaki medical journal","bibliographic_titleLang":"en"}]}]},"item_3_description_8":{"attribute_name":"記事種別(日)","attribute_value_mlt":[{"subitem_description":"症例報告","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_3_identifier_14":{"attribute_name":"URL","attribute_value_mlt":[{"subitem_identifier_type":"URI","subitem_identifier_uri":"http://igakkai.kms-igakkai.com/wp/wp-content/uploads/2014/KMJ-J40(2)103.pdf"}]},"item_3_relation_20":{"attribute_name":"DOI","attribute_value_mlt":[{"subitem_relation_type_id":{"subitem_relation_type_id_text":"https://doi.org/10.11482/KMJ-J40(2)103","subitem_relation_type_select":"DOI"}}]},"item_3_source_id_1":{"attribute_name":"雑誌書誌ID","attribute_value_mlt":[{"subitem_source_identifier":"AN00045593","subitem_source_identifier_type":"NCID"},{"subitem_source_identifier":"AN12940574","subitem_source_identifier_type":"NCID"}]},"item_3_source_id_19":{"attribute_name":"ISSN","attribute_value_mlt":[{"subitem_source_identifier":"0386-5924","subitem_source_identifier_type":"PISSN"},{"subitem_source_identifier":"2758-089X","subitem_source_identifier_type":"EISSN"}]},"item_3_text_6":{"attribute_name":"著者所属(日)","attribute_value_mlt":[{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学1"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学耳鼻咽喉科学"},{"subitem_text_language":"ja","subitem_text_value":"川崎医科大学総合内科学1"}]},"item_3_text_7":{"attribute_name":"著者所属(英)","attribute_value_mlt":[{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine 1, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Otorhinolaryngology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine 1, Kawasaki Medical School"}]},"item_3_textarea_10":{"attribute_name":"抄録(日)","attribute_value_mlt":[{"subitem_textarea_language":"ja","subitem_textarea_value":"症例は66歳男性で,30本/日の喫煙歴がある.両肩にピリピリしたしびれ感が出現し,その後両上肢と左下肢の動きにくさが出現しその後急激に四肢の筋力が低下し歩行できなくなり,自力で呼吸もできなくなったため緊急入院.気管切開を施行し,人工呼吸器の使用を開始した.頸髄MRIにてC3-6レベルに異常信号域を認め,脊髄梗塞が疑われた.四肢麻痺(左上下肢は不全麻痺,右上下肢は完全麻痺)を認めた.腱反射は左上下肢および右上肢で消失しており,病的反射はみられなかった.両上肢および臍部以下の温痛覚低下を認めたが,触覚や深部感覚は正常であった.頸髄MRIではC3-6レベルにT2強調画像で高信号域を認めた.急性の発症であることや頸髄MRI所見から脊髄梗塞と診断し,オザグレルナトリウム,エダラボン投与とリハビリテーションを開始し,呼吸状態は改善し人工呼吸器から離脱した.左上下肢および右下肢の筋力はやや改善を認めたが,自立歩行できない状態が残存した.右上肢は手指の動きが出てきたが,挙上はできない状態が残存した.脊髄梗塞は稀な疾患であり,その原因としては動脈硬化が多く,その他として大動脈解離,血管奇形,腫瘍塞栓,血管炎,手術や血管造影による医原性,椎間板ヘルニアなどがある.本例では明らかな大動脈解離がなく,血液検査で炎症所見が見られず,頸動脈超音波検査で両総頸動脈のIMT(内膜中膜複合体厚)肥厚を認め,頭部MRIで左椎骨動脈より右椎骨動脈の血管径が細く,頭部MRAの原画像で右椎骨動脈の血流信号が欠如していたことから,原因としては喫煙による動脈硬化が考えられた.急激に発症した四肢麻痺を見た場合には,脊髄梗塞の可能性があることも念頭に置き脊髄MRIを施行すべきと考える."}]},"item_3_textarea_11":{"attribute_name":"抄録(英)","attribute_value_mlt":[{"subitem_textarea_language":"en","subitem_textarea_value":"We report the case of a 66-year-old man, a heavy smoker (30 cig/day), diagnosed with spinal cord infarction. He had first noted an abnormal sensation in both shoulders. After that, he complained of acute onset of paralysis of all four limbs and trouble breathing. He was admitted to our hospital for emergency tracheostomy and endotracheal intubation. On neurological examination, he had left hemiparesis, right hemiparalysis, areflexia in both arms and left leg, disturbance of pain and temperature sensation in both arms and hypogastric region. His touch and deep sensation were normal. Spinal cord MRI revealed a high signal lesion at C3-6 level on the T2-weighted image. He was diagnosed spinal cord infarction because of the acute onset of symptoms and MRI findings. He was started on sodium ozagrel and edaravone, as well as rehabilitation. As his respiratory disturbance improved, he was weaned from respiratory support. Muscle strength of left arm and both legs improved slightly, but he could not walk. Muscle strength of right fingers improved slightly, but he could not raise his arm. Spinal cord infarction is a rare disease. Causes of spinal cord infarction are atherosclerosis, aortic dissection, vascular malformation, tumor thrombus, vasculitis, a herniated disk and iatrogenic causes such as surgery and angiography. Our patient did not have aortic dissection on chest and abdominal CT. Blood examination did not reveal findings of inflammation. Carotid artery ultrasonography revealed thickening of intima-media thickness of bilateral common carotid artery. Brain MRI revealed blood vessel diameter of right vertebral artery more narrow than left vertebral artery. Brain MRA revealed lack of blood flow signal of right vertebral artery. Consequently, we speculated that the cause of spinal cord infarction in this patient was atherosclerosis due to smoking. Thus, in patients with acute quadriplegia the possibility of spinal cord infarction should be considered, and spinal cord MRI should be performed. 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