Electrophysiological Assessment and Classification of Motor Pathway Function in Patients With Spinal Dural Arteriovenous Fistula.
Electrophysiological Assessment and Classification of Motor Pathway Function in Patients With Spinal Dural Arteriovenous Fistula.
复制标题
脊髓硬脑膜动静脉瘘患者运动通路功能的电生理评估和分类。
DOI：
10.1097/wnp.0000000000000526
复制
发表时间：
2019
影响因子：
2.4
通讯作者：
Adachi N.
中科院分区：
文献类型：
--
作者：
Nakanishi K;Tanaka N;Fujimoto Y;Nishikawa K;Kamei N;Nakamae T;Kotaka S;Adachi N.
目的：脊髓硬膜动静脉瘘（SDAVF）的诊断是困难的，往往延迟，因为临床特征往往是非特异性的。我们对SDAVF患者的运动功能进行电生理评估。方法：测定14例SDAVF患者（SDAVF组）、12例压缩胸椎脊髓病患者（CTM组）和16例正常人（对照组）经颅磁刺激后的运动诱发电位和电刺激后尺胫神经的复合肌动作电位和f波。计算幻觉外展肌外周传导时间（PCT-AH）和幻觉外展肌中枢运动传导时间（CMCT-AH）。根据神经学表现，将SDAVF组患者分为上运动神经元（UMN）体征和下运动神经元（LMN）体征两类。结果：SDAVF组和CMT组CMCT-AH明显长于对照组。SDAVF组PCT-AH明显长于对照组和CMT组。SDAVF组12例患者出现CMCT-AH和/或PCT-AH异常。在5例出现UMN和/或LMN征象的患者中检测到CMCT-AH和PCT-AH异常。CMCT-AH异常和PCT-AH正常的3例均出现UMN征。4例PCT-AH异常，CMCT-AH正常，均出现LMN征，无UMN征。结论：我们的研究发现了皮质脊髓束和/或下运动神经元的异常，并将SDAVF患者分为三种类型：UMN型，LMN型和混合型。
Purpose:The diagnosis of spinal dural arteriovenous fistula (SDAVF) is difficult and often delayed because clinical features are often nonspecific. We assessed the motor function electrophysiologically in patients with SDAVF.Methods:Motor-evoked potentials after transcranial magnetic stimulation and compound muscle action potentials and F-waves after electrical stimulation in the ulnar and tibial nerves were measured from the abductor hallucis (AH) muscles in 14 patients with SDAVF (SDAVF group), 12 patients with compressive thoracic myelopathy (CTM group), and 16 normal subjects (control group). The peripheral conduction time determined from abductor hallucis muscles (PCT-AH) and the central motor conduction time determined from abductor hallucis muscles (CMCT-AH) were calculated. According to the neurological findings, patients in the SDAVF group were classified to upper motor neuron (UMN) sign and lower motor neuron (LMN) sign categories.Results:CMCT-AH in the SDAVF and CMT groups were significantly longer than those in the control group. PCT-AH in the SDAVF group was significantly longer than that in the control and CMT groups. Twelve patients in the SDAVF group showed abnormal CMCT-AH and/or PCT-AH. Abnormal CMCT-AH and PCT-AH were detected in five cases that exhibited UMN sign and/or LMN sign. Three cases with abnormal CMCT-AH and normal PCT-AH exhibited UMN sign. LMN sign without UMN sign was observed in four cases with abnormal PCT-AH and normal CMCT-AH.Conclusions:Our study revealed abnormalities in the corticospinal tract and/or lower motor neurons, and classified the patients with SDAVF into three types: the UMN type, LMN type, and mixed type.