双语病例——脊髓前动脉综合征

朗读老师及翻译老师:周艺庭   呼和浩特市第一医院

History: A 37-year-old woman presented to the emergency department with acute onset of lower extremity weakness, low back pain, and urinary retention.

病史:37岁女性突发下肢无力、下背部疼痛、排尿困难,于急诊就诊

A complete spine MRI exam was performed. Select images are shown below. In order: sagittal T1-weighted fluid-attenuated inversion-recovery (FLAIR), sagittal T2-weighted, sagittal short tau inversion-recovery (STIR), and axial T2-weighted images. Click images to enlarge.

患者进行了完整的脊柱MRI检查。

部分图像如下所示,依次为:矢状位T1WI加权、 FLAIR、矢状位T2WI加权、STIR和轴位T2WI加权。点击图片放大。

Postcontrast images also were obtained. Shown below are a sagittal T1-weighted postcontrast and two axial T1-weighted volumetric interpolated breath-hold examination (VIBE) postcontrast images. Click images to enlarge.

增强图像:下图为矢状位T1WI加权增强图和两张轴位T1WI加权、 (VIBE)增强图。点击图片放大。

Findings

MRI shows the following:

  • Increased T2 signal and mild enhancement of the conus medullaris

  • Mild expansion of the conus medullaris

  • Enhancement of the ventral greater than dorsal roots of the cauda equina

  • Increased T2 signal in the posterior aspect of lower thoracic vertebral bodies with associated mild enhancement

影像表现,MRI示:

1、T2WI见脊髓圆锥信号增高并轻度强化;

2、脊髓圆锥轻度扩张

3、马尾腹侧强化程度高于背侧根侧

4、增强扫描见下位胸椎椎体后侧T2信号增高,伴轻度强化

Differential diagnosis

  • Spinal infarction

  • Guillain-Barré syndrome

  • Transverse myelitis

  • Neurosarcoidosis

  • Multiple sclerosis/acute disseminated encephalomyelitis (ADEM)

Diagnosis: Anterior spinal infarction

鉴别诊断:

1、脊髓梗死

2、格林巴利综合征

3、横贯性脊髓炎

4、神经系统结节病

5、多发性硬化/急性播散性脑脊髓炎(ADEM)

诊断:脊髓前动脉梗死

Discussion

Anterior spinal artery infarction/syndrome

Pathophysiology

  • The anterior spinal artery originates from branches of the vertebral arteries.

  • The artery of Adamkiewicz, which typically arises from the left aorta, is an additional important supplier of the anterior spinal artery in the lumbar and sacral regions.

  • Occlusion of or injury to the anterior spinal artery results in damage to the anterior spinal cord, including the corticospinal and spinothalamic tracts.

讨论:脊髓前动脉梗死/综合征

病理生理:

1、脊髓前动脉起源于椎动脉分支。

2、亚当凯维奇动脉通常起源于左主动脉,是腰椎和骶椎脊髓前动脉的另一个重要供给者。

3、脊髓前动脉的栓塞或损伤导致脊髓前损伤,包括皮质脊髓和脊髓丘脑束。

Epidemiology

  • In children, anterior spinal artery infarction is related to cardiac malformations and trauma.

  • In adults, it is primarilyy related to atherosclerotic disease. It is also associated with thoracoabdominal aneurysms, aortic surgery, emboli, dissection, systemic hypotension, arteriovenous malformations, coagulopathies, and cocaine use.

流行病学:

1、在儿童中,脊髓前动脉梗死与心脏畸形和创伤有关。

2、在成年人中,它主要与动脉粥样硬化疾病有关。它还与胸腹动脉瘤、主动脉手术、栓塞、夹层、全身性低血压、动静脉畸形、凝血功能障碍和可卡因使用有关。

Clinical presentation

  • The condition is most often acute in onset, with symptoms worsening over several hours to a day.

  • Patients present with a loss of motor function (corticospinal tract) and pain/temperature sensation (spinothalamic tract) at and below the level of the injury.

  • Paralysis is flaccid at first with reduced deep tendon reflexes with later onset of spastic paralysis and hyperreflexia.

  • Patients may also present with bowel and bladder dysfunction and sexual dysfunction.

临床表现

1、该病最常在发病时出现急性症状,症状在数小时至一天内不断恶化。

2、患者表现为在损伤水平及以下的运动功能(皮质脊髓束)和疼痛/温度感觉(脊髓丘脑束)的丧失。

3、瘫痪最初表现为松弛,深腱反射减弱,随后发作痉挛性瘫痪和反射亢进。

4、患者还可出现肠、膀胱功能障碍和性功能障碍。

Imaging features

MRI may demonstrate the following:

  • Restricted diffusion and T2 hyperintensity in the ventral/anterior spinal cord

  • Cord expansion

  • T1 shortening, which may reflect hemorrhagic transformation

  • Enhancement of the infarct in the acute phase

  • Signal abnormality and enhancement along the posterior vertebral bodies

影像学特征

MRI可能表现如下:

1、脊髓前/腹侧弥散受限,T2高信号

2、脊髓扩张

3、T1信号缩短,可能反映出出血性转化

4、急性期梗死强化

5、信号异常,椎体后部强化

Differential diagnosis

  • Guillain-Barré syndrome

  • Transverse myelitis

  • Arachnoiditis

  • Neurosarcoidosis

  • Multiple sclerosis/ADEM

鉴别诊断

1、格林巴利综合征

2、横贯型脊髓炎

3、蛛网膜炎

4、神经系统结节病

5、多发性硬化症/ADEM

Treatment and prognosis

  • Evidence for specific treatments in spinal infarction is lacking. There is minimal evidence for thrombolysis.

  • Most treatments are supportive and focus on the systemic complications of spinal cord dysfunction.

  • Up to 20% of patients will die.

治疗和预后

1、缺乏脊柱梗死的具体治疗方法的证据。溶栓作用的证据微乎其微。

2、大多数治疗是支持性的,重点是脊髓功能障碍的全身性并发症。

3、多达20%的患者将会死亡。

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