缺血性脊髓病的临床和影像学特征分析  

Analysis of clinical and imaging features of ischemic myelopathy

作　　者：矫黎东[1] 贾宇 宋旸[1] Jiao Lidong;Jia Yu;Song Yang(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

出　　处：《北京医学》2024年第5期366-369,373,共5页Beijing Medical Journal

摘　　要：目的总结缺血性脊髓病的临床和影像学特征。方法选取2015—2023年被误诊为急性脊髓炎,并于首都医科大学宣武医院最终确诊为缺血性脊髓病患者5例,回顾性分析患者的临床资料,总结患者的临床症状和影像学特点。结果5例患者中,男2例、女3例,中位发病年龄59岁,均为急性起病,表现为肢体无力、麻木等脊髓损害症状。5例患者的脊髓MRI示髓内异常信号,其中颈髓病变4例、腰膨大病变1例;轴位影像均出现典型“蛇眼征”特点5例,其中2例患者矢状位影像表现为“铅笔征”。患者发病早期应用免疫治疗后效果不佳。入院明确诊断后,给予抗凝或抗血小板药物治疗及脊髓功能康复治疗,症状有不同程度改善,但由于治疗延迟,均遗留肢体无力或麻木症状。结论脊髓髓内异常信号的特殊征象“蛇眼征”和“铅笔征”可作为缺血性脊髓病和急性脊髓炎的影像学重要鉴别要点。应提高以急性起病的脊髓损害症状患者特殊影像学征象的识别能力。Objective To summarize the clinical and imaging features of patients with ischemic myelopathy.Methods A total of five patients who were misdiagnosed as acute myelitis and finally diagnosed as ischemic myelopathy in Xuanwu Hospital of Capital Medical University from 2015 to 2023 were selected.The clinical data of the patients were analyzed retrospectively,and the clinical symptoms and imaging features were analyzed.Results Among the five patients,there were two males and three females,with median onset age of 59 years old.All of the patients had an acute onset of spinal cord damage such as weakness and numbness of the limbs.Spinal cord MRI showed abnormal intramedullary signals in five patients,including cervical myelopathy in four cases and lumbar bulging lesion in one case.Axial images showed typical"snake-eye sign"in five cases,and sagittal images showed"pencil sign"in two cases.The patients was treated with immunotherapy but leading to poor results.Anticoagulation or antiplatelet drugs and rehabilitation of spinal cord function was given after the definite diagnosis,and the symptoms improved to varying degrees,but all had left symptoms of limb weakness or numbness due to delayed treatment.Conclusions The special signs of spinal MRI,namely‘snake eye sign’and‘pencil sign’,can be used as the important imaging features to differentiate ischaemic myelopathy from acute myelitis.Physicians should improve the recognition of such images in patients with acute onset of spinal cord damage.

关 键 词：缺血性脊髓病 急性脊髓炎 蛇眼征 

分 类 号：R744[医药卫生—神经病学与精神病学]