Ajda BAL, Ece ÜNLÜ, Aytül CAKCI, İbrahim GÜNDOĞDU, Zeynep KIRAÇ ÜNAL

Akut Gelisen Parapleji Tablosu: DISH'li Bir Hastada İki Farklı Seviyede Bası

Diffüz İdiyopatik İskelet Hiperostozu (DISH); besinci dekattan sonra ve erkeklerde daha sık görülen, idiyopatik, ligament ve tendon yapısma bölgelerinde ossifikasyon ile karakterize kronik bir hastalıktır. DISH'e bağlı nörolojik tablolar ise oldukça nadir olup spinal kanal stenozu ve miyelopatiyi içermektedir. Ligamentum flavum ossifkasyonuna (LFO) bağlı torakal miyelopati ve nörolojik defisit gelisimi, oldukça az görülmektedir. Kauda equina sendromu ciddi bel ağrısının ön planda olduğu iki veya tek taraflı bel bacak ağrısı, eyer tarzı perianal hipoestezi veya anestezi, alt ekstremitede ilerleyici paraplejiye kadar gidebilen kuvvet kaybı, duyu kaybı ve idrar inkontinansı ile birlikte olabilir. Bu olgu sunumunda travma öyküsü olmayan DISH'li bir hastada, T9-10 seviyesinde kalsifiye ligamentum flavumun yaptığı spinal kord basısı ve es zamanlı L1-2 sekestre disk herniasyonunun yol açtığı kauda equina liflerinin basısına bağlı olabileceği düsünülen akut parapleji gelisiminin literatür bilgileri esliğinde sunulması amaçlanmıstır.

The Manifestation of Acute Developing Paraplegia: Pressure on Two Different Levels in a Patient with DISH

Diffuse Idiopathic Skeletal Hyperostosis (DISH) is an idiopathic chronic disease characterized by ossification in the ligament and tendon adhesion regions which are more common in men and after fifth decade. Neurological tables attached to DISH are very rare, including spinal canal stenosis and myelopathy. The development of thoracic myelopathy and neurological deficit attached to ligamentum flavum ossification (LFO) is rarely seen. Cauda equina syndrome may be accompanied by bilateral or unilateral leg pain with severe back pain, saddle-like perianal hypoesthesia or anesthesia, loss of strength as far as progressive paraplegia on the lower extremity, loss of sensation and urinary incontinence. In this case report, acute paraplegia, which is thought to occur due to calcified ligamentum flavum at T9-10 level caused by spinal cord pressure in a patient with DISH without trauma and spontaneous L1-2 seqestration as cause of pressure of cauda equina fibers, was aimed to be presented in the light of literature information.

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