脊髓短暂性缺血发作后脊髓梗死的临床观察  

Clinical observation of spinal cord infarction after spinal cord transient ischemic attack

作　　者：刘伟[1,2] 卫华 杨西西[1] 丁岩 Liu Wei;Wei Hua;Yang Xixi;Ding Yan(Department of Neurology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经内科,北京100053 [2]山东省诸城市人民医院神经内科一病区

出　　处：《北京医学》2023年第6期525-528,共4页Beijing Medical Journal

摘　　要：目的 探讨脊髓短暂性缺血发作(transient ischemic attack,TIA)的临床和影像学特点。方法 回顾性分析首都医科大学宣武医院收治的1例脊髓TIA患者的临床和影像学资料。结果 本例患者临床表现为反复双下肢麻木、无力,病情进行性加重。脊髓MRI提示T9椎体水平脊髓异常信号;计算机断层成像血管造影(computed tomography angiography,CTA)提示主动脉及其部分分支动脉硬化并多发管腔狭窄,肠系膜下动脉起始处管腔中度狭窄,腹主动脉远段及左侧髂总动脉局部溃疡形成。明确脊髓TIA诊断后给予抗凝及康复治疗,患者双下肢功能逐渐恢复至正常。结论 脊髓TIA患者中常见血管危险因素,患者临床表现常为急性发作,症状迅速达到高峰后迅速消退。尽早识别和处理脊髓TIA可避免病情发展为脊髓梗死,减少患者致残。诊断脊髓TIA时,应除外硬脊膜动静脉瘘、脱髓鞘性脊髓病等其他疾病可能。Objective To explore the clinical and imaging features of spinal cord transient ischemic attack(TIA).Methods The clinical and imaging data of a patient with spinal cord TIA in Xuanwu Hospital,Capital Medical University were retrospectively analyzed.Results The patient was undergoing progressive aggravation after repeated numbness and weakness of both lower limbs.Spinal cord MRI showed abnormal signals of T9 vertebral level of spinal cord.Computed tomography angiography(CTA) showed that arteriosclerosis and multiple lumen stenosis in the aorta and some of its branches,moderate lumen stenosis at the beginning of the inferior mesenteric artery,and local ulceration in the distal abdominal aorta and the left common iliac artery.Anticoagulation and rehabilitation were given after the diagnosis of spinal TIA,the function of both lower limbs gradually returned to normal.Conclusions Vascular risk factors are common in patients with spinal cord TIA.The clinical manifestations of patients are often acute attacks,the symptoms peak and subside quickly.Early identification and treatment of spinal TIA can prevent the disease from developing into spinal infarction and reduce the disability of patients.Other diseases such as dural arteriovenous fistula and demyelinating myelopathy should be excluded when diagnosing spinal TIA.

关 键 词：脊髓短暂性缺血发作 脊髓梗死 动脉粥样硬化 主动脉 

分 类 号：R744[医药卫生—神经病学与精神病学]