[Anterior spinal artery syndrome: an important differential diagnosis of acute non-traumatic transverse spinal cord syndrome].
[Anterior spinal artery syndrome: an important differential diagnosis of acute non-traumatic transverse spinal cord syndrome].
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脊髓前动脉综合征：急性非创伤性横贯脊髓综合征的重要鉴别诊断[J].
作者：
B. Schaller;P. Lyrer
我们报道了一位 77 岁的男性，他患有胸部疼痛（最初是环周疼痛），同时左腿感觉异常、波动性痉挛性截瘫以及 T8 节段尾部的分离性感觉障碍。在他的病史中，39 个月前，他曾因腹膜后肾内主动脉瘤破裂接受过主髂 Y 型假体治疗。诊断上，脊柱磁共振成像显示 C5-6 节段存在严重退行性变化，伴有骨狭窄，而 C6-7 节段则不太明显。没有脊髓病的迹象。颅神经计算机断层扫描结果与患者年龄相符。胸部和腹部的计算机断层扫描显示，胸动脉降支左侧有一个向外的隆起，长度近 20 毫米。根据鉴别诊断，这被解释为动脉瘤性囊肿伴壁血栓形成或解剖时局部局限性壁内血肿。通过磁诱发电位传导进行的电生理测试显示，腰骶部以上四肢的锥体束没有损伤。腰骶部刺激会诱发两侧电位，而皮质刺激则不会。根据患者的病史、临床表现和其他检查，尽管无法确定病因，但仍诊断为脊髓前动脉综合征。在本例中，先前的短暂性缺血发作和不同的病程是非常特殊的。
We report on a 77-year-old man who was suffering from pain in the chest, which was initially circumferential, along with paresthesia in his left leg, a fluctuating spastic paraparesis and dissociated sensory disturbances caudal to segment T8. In his history, he had received an aortoiliac Y-prothesis for a ruptured retroperitoneal intrarenal aortic aneurysm 39 months previously. Diagnostically, magnetic resonance imaging of the spine revealed advanced degenerative changes with osseous stenoses in segments C5-6 and less pronounced on C6-7. There were no signs of myelopathy. The results of the computerized tomogram of the neurocranium were consistent with the patient's age. The computerized tomogram of the chest and abdomen revealed a left outward bulge in the descending branch of the thoracic artery that was almost 20 mm in length. Based on the differential diagnosis, this was interpreted as an aneurysmatic sacculation with wall thrombosis or a locally circumscribed intramural hematoma upon dissection. Electrophysiologic testing by conduction of magnet-evoked potentials showed no lesions of the pyramidal tract to the extremities above the lumbosacral level. Lumbosacral stimulation evoked potentials on both sides whereas cortical stimulation did not. Based on the patient's history, the clinical findings and additional tests, the diagnosis of anterior spinal artery syndrome was rendered although its cause could not be determined with certainty. The previous transitory ischemic attack and the varying course of the disease is very exceptional in the presented case.