title: [A case of thoracic disc herniation with sudden onset paraplegia on toilet straining: case report].
abstract: Thoracic disc herniation is less common rather than cervical or lumbar herniation. Cases of sudden onset without trauma are especially rare. Generally, the neurological onset of disc herniation is caused by mechanical cord compression due to a protruded disc, and its onset is usually gradual. Ischemia is also considered as a factor of neurological onset. We report a case of a 78-year-old male with sudden paraplegia while straining at the toilet. T2 weighted MR image on admission showed mild disc protrusion at the level of Th8-9 and intramedullary high signal intensity below the Th8-9 level. We speculate that Valsalva-like maneuver had led to the congestion of vertebral venous plexus or compression of the anterior spinal artery, and spinal ischemia occurred.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo 060-8638, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yano
authors.forename: Kazutoshi
authors.initials: K
authors.lastname: Hida
authors.forename: Toshitaka
authors.initials: T
authors.lastname: Seki
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Iwasaki
authors.forename: Minoru
authors.initials: M
authors.lastname: Akino
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Saitou
mesh_terms: D000368:Aged; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D010264:Paraplegia / Q000175:diagnosis / Q000209:etiology*; D013117:Spinal Cord Compression / Q000175:diagnosis; D013904:Thoracic Vertebrae; D014636:Valsalva Maneuver