脊髓硬脊膜动静脉瘘三例  

3 cases of spinal dural arteriovenous fistula

作　　者：李秀 王莹 刘建强[2] 孙翠梅[2] Li Xiu;Wang Ying;Liu Jianqiang;Sun Cuimei(School of Clinical Medicine,Shandong Second Medical University,Shandong 261053,China)

机构地区：[1]山东第二医科大学临床医学院,山东261053 [2]淄博市中心医院

出　　处：《脑与神经疾病杂志》2024年第10期595-598,共4页Journal of Brain and Nervous Diseases

基　　金：山东省自然科学基金青年基金(ZR2020QH126)。

摘　　要：目的通过分析3例脊髓硬脊膜动静脉瘘(SDAVF)的病历特点,以提高对该病的认识及鉴别诊断水平,避免误诊误治。方法分析山东第二医科大学临床医学院3例SDAVF患者的临床表现、影像学特征、治疗及预后等。结果3例患者均为老年男性,表现为下肢运动障碍、深浅感觉障碍、大小便障碍,病程症状具有波动性,脊髓MRI可见髓内长节段异常信号灶,脊髓表面可见迂曲血管流空影像,糖皮质激素治疗会加重病情。3例患者均经脊髓血管造影明确诊断,后行硬脊膜动静脉瘘畸形血管切除术治疗后症状较前明显改善。结论硬脊膜动静脉瘘临床症状缺乏特异性,易与其他长节段脊髓疾病混淆,导致误诊误治。脊髓MRI可作为该病首选检查手段,一旦怀疑该病需及时完善脊髓血管造影,尽早行手术治疗。早期诊断和及时治疗才能更好改善预后。Objective To analyze the characteristics of 3 cases of spinal dural arteriovenous fistula(SDAVF)in order to strengthen the understanding and differential diagnosis of the disease and avoid misdiagnosis and mistreatment.Methods The clinical manifestations,imaging,treatment and prognosis of 3 patients with SDAVF were analyzed.Results The three patients,all aged males,presented with lower extremity motor disorders,deep and shallow sensory disorders,and defecation and urination disorders.The symptoms of the disease were variable in course.Abnormal signal focus in long segments of the intramedullary segments could be seen on spinal cord MRI,and tortuously empty vascular flow images could be seen on the surface of the spinal cord,which could be aggravated by glucocorticoid therapy.All the 3 patients were diagnosed by spinal angiography,and their symptoms were significantly improved after vascular resection of dural arteriovenous fistula.Conclusion The clinical symptoms of dural arteriovenous fistula lack specificity and are easily confused with other long segment spinal cord diseases,leading to misdiagnosis and mistreatment.Spinal MRI can be used as the first choice for this disease.Once suspected,spinal angiography should be improved in time and surgical treatment should be performed as soon as possible.Early diagnosis and timely treatment can improve the prognosis.

关 键 词：硬脊膜动静脉瘘 视神经脊髓炎谱系疾病 数字减影血管造影 误诊 

分 类 号：R744[医药卫生—神经病学与精神病学]