脊髓梗死合并缺血缺氧性脑病1例报道并文献复习  

Spinal cord infarction complicated with hypoxic-ischemic encephalopathy:a case report and literature review

作　　者：谢晓娟 张海艳 郭叶群 倪啸晓 Xie Xiao-Juan;Zhang Hai-Yan;Guo Ye-Qun;Ni Xiao-Xiao(Department of Hyperbaric Oxygen Rehabilitation,General Hospital of Southern Theater Command of PLA,Guangzhou,Guangdong 510010,China)

机构地区：[1]解放军南部战区总医院高压氧康复科,广东广州510010

出　　处：《解放军医学杂志》2025年第3期318-323,共6页Medical Journal of Chinese People's Liberation Army

摘　　要：目的 探讨脊髓梗死合并缺血缺氧性脑病的临床特点与诊治对策。方法 报道解放军南部战区总医院2021年6月收治的1例心跳呼吸骤停引发脊髓梗死患者的病例资料,并复习Pub Med、中国知网2014年1月-2024年3月发表的相关文献,总结脊髓梗死的病因、特征和治疗方案。结果 本病例临床特征为四肢无力伴麻木,腰背部疼痛麻木,吞咽、言语困难,大小便障碍;MRI检查提示颈_2-胸_1水平脊髓前索及外侧索异常信号,增强扫描未见强化;诊断为脊髓梗死合并缺血缺氧性脑病,给予抗血小板和康复治疗。复习文献发现,脊髓梗死是中枢神经系统的罕见疾病,病因较多,多由主动脉手术或主动脉病变引起,具有节段性感觉障碍等多种临床表现,MRI可在其诊断中发挥重要作用,但目前尚缺少特效的治疗方法。结论 脊髓梗死发病急,起病隐匿,多与其他疾病相伴行,容易漏诊误诊。本病例脊髓梗死原因考虑低血压和椎动脉纤细引起,主要临床表现为病变平面下截瘫,四肢无力伴麻木,腰背部疼痛麻木;诊断首选MRI,治疗包括卒中二级预防、康复训练、预防并发症及高压氧治疗等。Objective To investigate the clinical characteristics and management strategies of spinal infarction(SCI)combined with hypoxic-ischemic encephalopathy(HIE).Methods We report a case of SCI induced by cardiopulmonary arrest in a patient admitted to the General Hospital of Southern Theater Command in June 2021.A review of the relevant literature published in PubMed and CNKI from January 2014 to March 2024,was conducted to summarize the etiology,features,and treatment approaches for SCI.Results The patient presented with clinical features of quadriplegia accompanied by paresthesia,lumbar and cervical pain with paresthesia,dysphagia,dysphonia,and urinary and fecal incontinence.Spinal MRI revealed abnormal signals in the anterior and lateral columns at the C2-T1 spinal level,with no enhancement observed in contrast-enhanced scan.The patient was diagnosed as SCI combined with HIE,and was treated with antiplatelet therapy and rehabilitation.Literature review revealed that SCI is a rare central nervous system disease with multiple causes,often related to aortic surgery or pathology,presenting with segmental sensory disturbances among other clinical manifestations.MRI plays a significant role in its diagnosis,and there is currently no specific effective treatment available.Conclusions SCI has a sudden onset and is often insidious,frequently accompanying other diseases,leading to a high risk of misdiagnosis.In this case,SCI was considered to be caused by low blood pressure and vertebral artery tenuity.Clinical manifestations include paraplegia at the lesion level along with back/neck pain or limb paresthesia.Diagnosis primarily relies on MRI imaging while treatment involves secondary stroke prevention measures,rehabilitation training,complication prevention strategies as well as hyperbaric oxygen therapy.

关 键 词：脊髓梗死 脊髓前动脉综合征 脊髓缺血 缺血缺氧性脑病 

分 类 号：R744[医药卫生—神经病学与精神病学] R742[医药卫生—临床医学]