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題 名 | Legionellosis Complicated with Transverse Myelitis: A Case Report and Review of Literatures=退伍軍人症引發橫貫性脊髓炎:一病例報告及文獻回顧 |
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作 者 | 戴佩玲; 葉本芳; 王凱震; 李明政; 郭文雄; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 12:3 2011.09[民100.09] |
頁 次 | 頁140-146 |
分類號 | 415.4 |
關鍵詞 | 急性橫貫性脊髓炎; 退伍軍人症; 退伍軍人性肺炎菌; Acute transverse myelitis; Legionella pneumophila; Legionnaire's disease; |
語 文 | 英文(English) |
中文摘要 | 急性橫貫性脊髓炎是退伍軍人症引發神經病變中最罕見的併發症而且在英文文獻中未曾發表過。本病例報告描寫一位病患因嚴重退伍軍人性肺炎迅速進展為急性呼吸衰竭及腎臟衰竭使用呼吸器和洗腎治療。在加護病房無法配合呼吸器故予鎮靜劑使用,於過程中無法有效評估神經學反應,導致病人出現神經障礙卻被掩蓋。幸好抗生素治療有效而且早期使用類固醇加上積極復健,出院時雙下肢的感覺和運動神經功能獲得改善。但出院一年後門診追蹤病人仍然無法正常排尿並需要定時導尿。在這裡藉此提醒大家在照顧使用鎮靜劑的病人時,務必暫時關閉藥物並且定期評估神經學反應,予避免忽略症狀而延誤診斷及其治療。 |
英文摘要 | Acute transverse myelitis is a rare neurologic complication of legionnaire’s disease. To the best of our knowledge, this is the first case report of acute transverse myelitis associated with legionnaire’s disease in english literature. Herein, we describe a case of rapidly progressing legionella pneumonia complicated with acute respiratory and renal failure. Ventilator assistance and hemodialysis were initiated. The patient developed neurologic deficits while in respirator and manifestations were masked by sedation. After steroid and intensive physical therapy, sensori-motor impairments of both lower extremities improved but sequelae of neurogenic bladder continue to persist during one year of follow-up care after discharge. This article aims to alert health personnels to be aware of the neurologic deficit arising in intubated patient under sedation in the intensive care unit. We believe waking patient in time interval is not sufficient but frequent neurologic assessment of patient is necessary to avoid overlooking any neurologic manifestations. |
本系統中英文摘要資訊取自各篇刊載內容。