CASE REPORT

Síndrome da Medula Branca. Relato de caso

White Cord Syndrome. Case report

  • André Cerutti Franciscatto 1    André Cerutti Franciscatto 1
  • Larissa Bruch Caetano 2    Larissa Bruch Caetano 2
  • Eduardo Goellner 3    Eduardo Goellner 3
  • Jair Dacás 4    Jair Dacás 4
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Resumo

Introdução: Deterioração neurológica súbita pode surgir após descompressão medular decorrente de lesão por reperfusão da medula espinal. Essa lesão edematosa e isquêmica é uma condição rara conhecida como “Síndrome da Medula Branca” (SMB). Relato de caso: Paciente de 41 anos com histórico de piora progressiva de parestesias, formigamentos, dificuldade intermitente de equilíbrio e dor nos membros superiores bilateralmente há 3 anos. Submetido a laminectomia descompressiva C4 a C7 e artrodese com parafusos em massa lateral. O procedimento transcorreu sem intercorrências. No pós-operatório imediato, o paciente manifestou tetraparesia assimétrica. A ressonância magnética (RM) demonstrava hipersinal na sequência T2, no interior da medula espinal, aos níveis de C4- C6. Discussão: A etiologia da síndrome da medula branca é atribuída à rápida expansão do tecido medular, com aumento abrupto do suprimento sanguíneo na área afetada. O diagnóstico da SMB é um diagnóstico de exclusão. Os achados da RM medular são descritos como áreas de hiperintensidade tanto na substância cinzenta quanto NA substância branca, na sequência T2 e FLAIR. Conclusão: Um debate aprofundado na literatura é encorajado a fim de esclarecer e determinar a frequência, riscos e fatores prognósticos, bem como melhores estratégias terapêuticas nesses casos.

Palavras-chave

Mielopatia, Síndrome da Medula branca, Descompressão medular

Abstract

Background: Sudden neurological deterioration can emerge following spinal decompression due to reperfusion injury of the spinal cord. This ischemic-edematous lesion is rare condition known as “white cord syndrome” (WCS). Case Presentation: A 41 year-old male was referred with a 3-year-history of worsening paresthesias, numbness, intermittent balance difficulties, and pain in the bilateral upper extremities. The patient underwent C4-C7 posterior decompression via laminectomy and C3-C7 instrumented arthrodesis via lateral mass screw-rod arthrodesis. The procedure was uneventful. Asymmetric tetraparesis in the immediate postoperative period was depicted. The MRI showed expected postoperative changes, but T2-weighted scans showed an increased hyperintense signal of the spinal cord at the C5-C6 levels. Discussion: The etiology is attributed to rapid cord expansion with acutely increased blood supply to the affected area. Diagnosis of WCS is a diagnosis of exclusion. Postoperative MRI findings of spinal cord changes are described as high-intensity areas both in the gray and white matter on FLAIR and T2-weighted MRI sequences. Conclusion: A sharp debate in the literature is encouraged in order to clarify and assess frequency, risks, prognostic factors along with the best therapeutic strategy in these cases.

Keywords

Myelopathy, White Cord Syndrome, Spine decompression

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1MD, MSc, Neurosurgeon, Serviço de Neurologia e Neurocirurgia, Ineuro, Porto Alegre, RS, Brazil.

2MD, Neurosurgeon, Serviço de Neurologia e Neurocirurgia, Ineuro, Porto Alegre, RS, Brazil.

3MD, MSc, Neurosurgeon, Hospital de Clínicas de Porto

4MD, Hospital Porto Alegre, Porto Alegre, RS, Brazil.

 

Received May 28, 2020

Accepted May 14, 2024

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JBNC  Brazilian Journal of Neurosurgery

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