脑桥梗死后脊髓华勒变性致痉挛性截瘫二例临床分析  

Clinical analysis of two cases of spastic paraplegia caused by Wallerian degeneration in lateral corticospinal tracts after pontine infarction

作　　者：葛晓燕[1] 贾国勇[1] 刘颖[1] 李怡[1] 王翠兰[1] Ge Xiaoyan;Jia Guoyong;Liu Ying;Li Yi;Wang Cuilan(Department of Neurology,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]山东大学齐鲁医院神经内科,济南250012

出　　处：《中华神经科杂志》2021年第5期463-469,共7页Chinese Journal of Neurology

摘　　要：目的:探讨脑桥梗死后脊髓华勒变性致痉挛性截瘫患者的临床表现及影像学特征,分析其发生过程和机制。方法:报道2例脑桥梗死后脊髓华勒变性致痉挛性截瘫患者的临床表现及影像学特征,结合解剖及文献复习系统分析脑桥梗死后脊髓侧索华勒变性的产生机制、影像学表现及其临床特点。结果:例1为65岁女性,例2为58岁男性,分别于2018年12月7日和2019年6月23日就诊于山东大学齐鲁医院。2例患者均表现为脑桥梗死数月后缓慢起病并进展的双侧肢体肌力减弱、肌张力增高、腱反射活跃,病理征阳性,符合上运动神经元损害所致的痉挛性截瘫,例1是在脑桥梗死后8个月出现,例2在脑桥梗死后6个月出现。磁共振成像均可见脑桥病灶以下连续的双侧锥体束等T 1、长T 2信号,例1表现为延髓、颈髓、胸髓侧索病变,例2表现为延髓、颈髓侧索病变。对2例患者均行肌电图检查、实验室检查排除运动神经元病及代谢性疾病,1例行脑脊液检查排除炎性脱髓鞘疾病。根据其症状、体征及磁共振成像所示与原发病灶相连且与锥体束走行一致的连续条状异常信号,最终诊断为脑桥梗死后脊髓华勒变性。随访发现2例患者临床症状均进行性加重。结论:脑桥梗死后脊髓华勒变性致肢体痉挛性瘫痪是疾病的发生发展过程,与疾病预后相关,充分认识其临床表现及影像特点可以避免临床误诊误治。Objective To investigate the clinical manifestations and imaging features of spastic paraplegia caused by spinal cord Wallerian degeneration after pontine infarction,and to analyze its occurrence process and mechanism.Methods The clinical manifestations and imaging features of two patients with spastic paraplegia caused by spinal cord Wallerian degeneration after pontine infarction were reported for the first time in China.Combined with anatomy and review of the literature,the mechanism,imaging manifestations and clinical features of Wallerian degeneration of lateral funiculus of spinal cord after pontine infarction were analyzed systematically.Results Case 1 was a 65 years old female,and case 2 was a 58 years old male,who were treated in Qilu Hospital of Shandong University on December 7,2018 and June 23,2019 respectively.All the two patients presented with strength weakness of both limbs,hypertonia,symmetric hyperreflexia,and bilateral extensor plantar responses,which suggested spastic paraplegia secondary to upper motor neuron involvement.Spastic paraplegia appeared eight months after pontine infarction in case 1 and appeared six months after pontine infarction in case 2.Magnetic resonance imaging revealed continuous iso-T1 and high-T2 signals of bilateral pyramidal tracts below the pontine foci.Case 1 showed lesions of lateral cord of medulla oblongata,cervical spinal cord and thoracic spinal cord,and case 2 showed lesions of lateral cord of medulla oblongata and cervical spinal cord.At the same time,motor neuron disease and metabolic disease were excluded by electromyography and laboratory examination,inflammatory demyelinating disease was excluded by cerebrospinal fluid examination in one case.The syndromes,in combination with a continuous strip of abnormal signal revealed by magnetic resonance imaging which was consistent with the pyramidal tract and connected with the primary lesion suggested wallerian degeneration of spinal cord secondary to pontine infarction.The clinical symptoms of two cases were grad

关 键 词：脑梗死 华勒变性 脊髓 磁共振成像 痉挛性截瘫 

分 类 号：R743.33[医药卫生—神经病学与精神病学]