脊髄梗塞を発症した維持透析患者の１例

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  • Sudden onset of spinal cord infarction after a hemodialysis session in an elderly hemodialysis patient

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A 74 year-old male hemodialysis (HD) patient with a HD duration of 1 year underwent a resection of the ulnar nerve neurinoma on June, 2003. One week after the surgery, 2 hours after the cessation of a routine 4-hour HD without any complications, he suddenly complained epigastralgia referred across the upper abdominal wall. Then, numbness and muscle weakness of both lower legs developed, and finally paralytic paraplegia was completed within several hours. On the next morning, paraplegia had still persisted, and the dissociated anesthesia below the level of Th8, rectal obstruction, and areflexia were newly observed. Most possible cause for his symptoms and signs was considered to be vascular accident of the spinal cord, we performed MR imaging on the same day. MR imaging revealed spinal swelling lesions on T1-weighted image which was high-intensity lesion on T2-weighted image at the level between Th8 and Th12, indicating spinal cord infarction. The administration of both argatroban (60mg/day day 1-2) and glycerin (200mL×2/day day 1-7) in conjunction with hyperbaric oxygenation was started. Rehabilitation was started 7 days after the onset, although the improvement of his symptoms was not evident. He was repeatedly complicated with pneumonia due to the difficulty in expectoration.<br>There are a few case reports in which spinal cord infarction was diagnosed by MR imaging in HD patients. The present case showed the typical course and MR images of the disease. The severe systemic arteriosclerosis was considered to be a causative etiology for the onset.

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