以双下肢无力麻木为首发表现的主动脉夹层1例并文献复习  

Aortic dissection with weakness and numbness of both lower limbs as the first manifestation:A case report and literature review

作　　者：张永志[1] 李艳敏[1] 马晓雯 顾平[1] Zhang Yongzhi;Li Yanmin;Ma Xiaowen;Gu Ping(Department of Neurology,the First Hospital of Hebei Medical University,Hebei Hospital of Xuanwu Hospital Capital Medical University,Shijiazhuang 050031,China,Neuromedical Technology Innovation Center of Hebei Province,Shijiazhuang 050051,China;Department of Ultrasound,Brain Aging and Cognitive Neuroscience Laboratory of Hebei Province,Neuromedical Technology Innovation Center of Hebei Province,Shijiazhuang 050051,China)

机构地区：[1]河北医科大学第一医院、首都医科大学宣武医院河北医院神经内科,河北省脑老化与认知神经科学实验室,河北省神经医学技术创新中心,河北石家庄050051 [2]河北医科大学第一医院、首都医科大学宣武医院河北医院超声科,河北石家庄050051

出　　处：《临床荟萃》2023年第10期912-916,共5页Clinical Focus

基　　金：河北省卫生健康委员会科研基金资助项目帕金森病患者血清炎性因子水平的变化与伴发自主神经功能障碍的关系(20210310);河北省科技厅民生科技专项河北省重点研发计划资助项目八段锦锻炼对帕金森病患者机体功能影响的临床研究(20377721D)。

摘　　要：目的探讨以神经系统症状为首发症状的主动脉夹层(aortic dissection,AD)的发生情况及转归预后。方法回顾性分析1例以双下肢无力麻木为首发表现的AD患者的病例资料,并复习相关文献。结果患者男性,32岁,以“双下肢麻木无力1小时”为主诉就诊。既往高血压病史。入院前1小时于骑自行车时突然出现双下肢麻木无力,症状进展迅速,于10分钟内双下肢力量完全消失。神经系统查体,双下肢肌力0级、肌张力降低;双侧膝反射和踝反射未引出,T12平面以下深浅感觉消失。结合凝血常规、心脏彩色超声及主动脉CT血管成像,诊断为AD(Starnfor A型)。患者及家属拒绝手术治疗,后内科保守治疗无效死亡。结论以神经系统症状为首发表现的AD较罕见,本文报告1例以无疼痛症状的孤立性脊髓损伤为首发表现的AD患者,同时结合相关文献进行分析,为临床提高诊疗效果,减少病死率提供参考。Objective To investigate the occurrence and prognosis of aortic dissection(AD)with neurological symptoms as the first symptom.Methods Clinical data of a case of AD with weakness and numbness of both lower limbs as the initial manifestation were retrospectively analyzed.Relevant literatures were reviewed as well.Results A 32-year-old male patient presented with numbness and weakness of both lower limbs for 1 hour.He had previous history of hypertension.One hour before admission,he suddenly appeared numbness and weakness of both lower limbs when riding a bicycle,and the symptoms progressed rapidly.Within 10 minutes,the strength of both lower limbs completely disappeared.Neurological examination showed grade 0 of limb muscle strength on both lower limbs,and decreased muscle tension.Bilateral knee and ankle reflexes were not elicited.Depth and superficial sensation below the plane of the 12th thoracic vertebra(T12)were lost.Babinski sign of both lower limbs was negative.Combined with coagulation routine test,cardiac ultrasound and aortic CT angiography,the patient was diagnosed as AD(Starnfor type A).However,the patient and his family refused surgical treatment,and later died after the failure of conservative treatment.Conclusion AD neurological symptoms as the first symptom is rare.This paper reporteda case of AD with isolated spinal cord injury and absence of painful symptoms as the first presentation.Through literature review,our case report provided references for clinical improvement of diagnosis and treatment and reduction of mortality rate.

关 键 词：动脉瘤 夹层 下肢无力 病例报告 

分 类 号：R543.12[医药卫生—心血管疾病]