颈段椎管内神经鞘瘤引起蛛网膜下腔出血病例报告并文献复习  

Subarachnoid hemorrhage caused by schwannoma in cervical spinal canal:a case report and literature review

作　　者：谭娟英 杨可达[2] 柳茵[3] 胡中扬[1] TAN Juanying;YANG Keda;LIU Yin(Department of Neurology,The Third Xiangya Hospital of Central South University,Changsha 410000,China)

机构地区：[1]中南大学湘雅三医院神经内科,湖南长沙410000 [2]中南大学湘雅医院病理科,湖南长沙410000 [3]中南大学湘雅三医院放射科,湖南长沙410000

出　　处：《中风与神经疾病杂志》2024年第7期646-650,共5页Journal of Apoplexy and Nervous Diseases

基　　金：湖南省自然科学基金委员会;湖南省自然科学基金面上项目(2020JJ4835)。

摘　　要：分析中南大学湘雅三医院收治及文献报道的表现为蛛网膜下腔出血(SAH)的椎管内神经鞘瘤病例共19例,以总结椎管内神经鞘瘤引起蛛网膜下腔出血的临床特征。本报道涉及的患者临床表现为剧烈头痛呕吐,无脊髓及神经根受压症状,腰穿结果证实了SAH,患者全脑血管造影未提示颅内动脉瘤及血管畸形,脊髓MRI示颈段髓外硬膜内肿瘤,经手术治疗,病理活检结果诊断神经鞘瘤。文献报道的部分病例除了SAH,还有脊髓及神经根受压症状。该类疾病的临床特点提示临床医生颅内影像学检查阴性的SAH患者应明确有无神经根或脊髓受压的症状体征,并运用合理的检查排查椎管内病变,早期诊断和完全切除肿瘤不仅可以防止出血复发,还可以有效避免椎管内占位性病变的压迫所带来的脊髓及神经根的不可逆损伤,有利于改善患者的预后。This study aims to summarize the clinical features of subarachnoid hemorrhage(SAH)caused by intraspinal schwannoma by analyzing 19 cases of intraspinal schwannoma manifesting as SAH who were admitted to our hospital or reported in the literature.The patients in this study had the clinical manifestation of severe headache and vomiting,without the symptoms of spinal cord or nerve root compression.Lumbar puncture confirmed SAH,and cerebral digital subtraction angiography did not show intracranial aneurysms or vascular malformations.Spinal cord MRI showed extramedullary intradural tumor in the cervical segment,and pathological biopsy results confirmed the diagnosis of schwannoma.Some cases reported in the literature not only presented with SAH but also had the symptoms of spinal cord and nerve root compression.The clinical features of this disease suggest that clinicians should clarify the presence or absence of the symptoms or signs of nerve root or spinal cord compression in SAH patients with negative intracranial imaging findings and perform reasonable examinations to exclude intraspinal lesions.Early diagnosis and complete tumor resection can not only prevent bleeding and recurrence,but also effectively avoid irreversible damage to the spinal cord and nerve roots caused by the compression of intradural lesions in the spinal canal,thereby helping to improve the prognosis of patients.

关 键 词：脊髓神经鞘瘤 蛛网膜下腔出血 病因 影像学检查 机制 

分 类 号：R743.35[医药卫生—神经病学与精神病学]