
DOI: 10.1055/s-0036-1581084
Herniação medular idiopática – relato de caso
Idiopathic Spinal Cord Herniation – Case ReportPublication History
20 October 2015
06 February 2016
Publication Date:
14 April 2016 (eFirst)

Resumo
Herniação medular idiopática é uma causa rara de mielopatia progressiva, especialmente na ausência de história clínica de trauma raquimedular ou cirúrgico. O diagnóstico radiológico é feito por meio de mielotomografia ou ressonância magnética. A medula espinal é deslocada anteriormente, tamponando o defeito dural e levando na maioria dos casos a uma síndrome de Brown-Séquard. O presente estudo demonstra o caso de um paciente do sexo masculino com quadro clínico de mielopatia torácica progressiva. Na investigação clínica e radiológica, foi identificada uma herniação medular idiopática ao nível torácico. Durante a cirurgia, a medula espinal foi reduzida ao local natural, tomando sua forma elíptica habitual, e a falha dural foi reparada com substituto dural. O paciente melhorou da dormência, e houve desaparecimento dos choques nos membros inferiores. A ressonância pós-operatória confirmou a redução cirúrgica da herniação e o restabelecimento de coluna liquórica anterior à medula espinal. Os autores descreveram os achados clínicos, radiológicos e intraoperatórios, bem como a evolução pós-operatória.
Abstract
Idiopathic spinal cord herniation is a rare cause of progressive myelopathy, especially in the absence of a history of spinal or surgical trauma. Myelography or MRI makes the radiological diagnosis. The spinal cord is pushed anteriorly, buffering the dural defect and leading in most cases to Brown-Séquard syndrome. This study demonstrates the case of a male patient with clinical picture of progressive thoracic myelopathy. In clinical and radiological investigation was identified idiopathic spinal cord herniation to the chest level. During surgery, the spinal cord was reduced to the natural site, taking his usual elliptical shape, and the dural defect was repaired with dural substitute. The patient improved the numbness and shock disappearance of the lower limbs. Postoperative resonance confirms the surgical reduction of herniation and restoring previous CSF column to the spinal cord. The authors described the clinical, radiological, intraoperative, and postoperative evolution.
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