以脊髓损害为首发的主动脉夹层临床特点

目的探讨以脊髓病变为首发的主动脉夹层患者的临床及神经影像学特点。方法对7例以脊髓损害为首发的主动脉夹层患者进行病史回顾、临床分析及超声心动图、CT血管成像和脊髓MRI检查。结果 7例主动脉夹层患者临床表现与急性脊髓炎、脊髓出血等相似如急性截瘫、尿便障碍等。此外,还伴有急性胸背痛、肾衰、血小板计数进行性下降、骨骼肌缺血坏死导致的肌酶谱增高等,且均伴有高血压病。超声心动图和CT血管成像、MRI可见主动脉真假双腔形成。由于其临床表现与急性脊髓炎、脊髓出血等相似,易导致贻误诊断,增加死亡率。结论以脊髓病变为首发的动脉夹层,发病急骤,误诊率高,超声心动图、CT血管成像及MRI检查对诊断具有重要价值,临床医生应加强对以急性脊髓损伤为首发的主动脉夹层的认识,从而有助于早期诊断,减少死亡率。     

以急性横贯性脊髓缺血性损伤为首发症状的主动脉夹层动脉瘤1例报告

<正>主动脉夹层动脉瘤(Aortic Dissection,AD)是指由于主动脉内膜局部撕裂,导致血液通过内膜的破口流入主动脉壁各层之间形成夹层血肿,并迫使主动脉壁各层分开,常表现为突然发作的剧烈撕裂性疼痛。AD是一种临床急症,猝死率极高。以急性横贯性脊髓缺血性损伤起病的主动脉夹层动脉瘤临床上少见,并易与急性脊髓炎混淆。现将1例以脊髓缺血性损伤起病的主动脉夹层动脉瘤患者报道如下。1临床资料     

并发神经系统损害的主动脉夹层影像学分析

目的分析并发神经系统损害的主动脉夹层的临床和影像学特点。方法回顾分析12例并发神经系统损害的主动脉夹层的临床资料。结果以中老年为主,男女之比为2∶1,10例有高血压史,均为急性起病,均有明显的疼痛,发病时均有明显的血压异常,4例伴恶心、呕吐、大汗。神经系统表现:偏瘫4例,截瘫5例,单侧下肢瘫痪3例,偏身感觉障碍4例,感觉异常平面5例,失语1例,声音嘶哑、吞咽困难1例,大小便障碍2例。结论彩超、CTA、MRA可显示主动脉真假腔并为诊断提供依据。     

主动脉夹层并发神经系统损害的临床和影像学特征

目的探讨主动脉夹层并发神经系统损害的临床和影像学特征。方法回顾性分析14例主动脉夹层并发神经系统病变患者的临床资料。结果本组患者中>40岁中老年人13例(92.9%),均为急性起病,有高血压病史9例,发病时血压升高9例、降低3例、测不到2例;临床表现:剧烈胸痛5例,胸背痛4例,腹痛、腰痛伴呕吐2例,休克2例;神经系统表现:眩晕5例,意识障碍4例,偏瘫2例,言语不清1例,截瘫2例,感觉减退3例(1例偏身,2例胸4、胸6平面以下)。14例胸腹部CT CTA均显示主动脉真假腔,并清晰见内膜裂口位置(DebakeysⅠ型2例,Ⅱ型7例,Ⅲ型5例)及附壁血栓,其中8例胸腹部MRI可见明显的真假腔,真腔呈流空信号,假腔T1及T2WI均呈高信号。结论主动脉夹层并发神经系统损害的主要临床表现为脑和脊髓缺血性损害的症状及体征。CT和MRI可显示主动脉夹层的假腔及血管内膜破裂口。     

以截瘫为主要表现的主动脉夹层血肿1例分析

<正>主动脉夹层(aortic dissection,AD)是指主动脉腔内的血液通过内膜的破口进入主动脉中层而形成的血肿,又称主动脉夹层血肿、主动脉夹层分离或主动脉夹层动脉瘤,临床上起病急,症状复杂多变,易漏诊、误诊而死亡。以截瘫为主要表现的AD国内罕见,现报道一例并结合文献分析讨论。     

以脊髓病变为首发表现的主动脉夹层1例报告

主动脉夹层以脊髓变为首发表现的患者少见,现将我院收治的1例报告如下.     

急性无痛性主动脉夹层导致的截瘫

目的:报道1例截瘫为仅有症状的无痛性急性主动脉夹层,探讨其发病机制,以提高对本病的认识。方法:查阅近年来相关的文献。结果:3%～5%的主动脉夹层病人合并截瘫,无痛性截瘫更为少见。截瘫大部分发生在下胸段及腰段,而发生在T4(一般认为的分水岭区)则少见。结论:主动脉夹层表现为无疼痛,而以截瘫为仅有的症状是非常少见的。截瘫发生在下胸段及腰段是因该部位脊髓前动脉侧支少,对Adam kiewicz动脉的依赖性大。     

以急性截瘫起病的无痛性主动脉夹层动脉瘤(附1例报告及文献复习)

目的报道1例以急性截瘫起病的无痛性主动脉夹层动脉瘤病例,提高临床工作中对该病的认识。方法回顾性分析1例以急性截瘫起病的无痛性主动脉夹层动脉瘤患者的临床资料,结合文献复习探讨以截瘫起病的主动脉夹层动脉瘤的起病方式、阳性体征、影像学资料等,并加以分析。结果包括本例及文献报道共计14例以截瘫起病的无痛性主动脉夹层动脉瘤患者,其中男性10例、女性3例。该病以双下肢麻木、乏力症状为主要表现。影像学检查以胸部CT等为其主要检查手段,辅助检查多有D-二聚体升高。病情凶险,预后不良。结论对骤然起病的截瘫患者,应常规进行胸部CT检查、D-二聚体检查等,排除主动脉夹层动脉瘤可能。     

71例急性DebakeyⅠ型主动脉夹层术后神经系统并发症分析

目的探讨急性DebakeyⅠ型主动脉夹层术后神经系统并发症的病因及处理方法。方法回顾性分析2012年我院急性DebakeyⅠ型主动脉夹层手术患者的临床资料和随访结果,对术后出现神经系统并发症病例进行分析。结果全组急诊手术71例,术后昏迷2例,术后CT提示1例为大面积脑梗死,8d后放弃治疗;另外1例5d后出现昏迷,急查颅脑CT,考虑颅内占位破裂,转入外院后死亡;暂时性精神障碍23例,其余均健康出院。随访3～12个月,所有暂时性精神障碍患者出院时症状均消失,随访期间均未再次出现精神症状。结论急性DebakeyⅠ型主动脉夹层急诊手术后神经系统并发症较严重,术前应根据患者病情决定术中脑保护方案。     

首发表现为截瘫的主动脉夹层1例报告并文献复习

<正>主动脉夹层(Aortic Dissection,AD)是一种严重的临床急症,典型表现为突发剧烈的胸腹部痛、以及可以放射至背部的疼痛[1,2]。主动脉夹层在普通人群中的发病率为每年2.6~3.5/10万,患者多为年龄在60~80岁的男性[3~5]。对近20 y文献进行检索发现,以急性截瘫、骨骼肌坏死及急性肾功能损害起病的无疼痛性主动脉夹层非常少见[6]。现报道     

Acute aortic dissection presenting as painful paraplegia

Aortic dissection is a rare potentially life threatening condition. Neurological complications such as paraplegia as presenting manifestation of aortic dissection are exceedingly rare. We describe a 60-year-old man who presented with acute onset paraplegia with bladder involvement, constricting pain in the lower abdomen, bradycardia and succumbed rapidly within 14h of onset of symptoms. Autopsy revealed an unexpected cause of paraplegia with extensive aortic dissection extending from origin to iliac bifurcation (DeBakey type I). The aorta showed extensive atherosclerosis causing medial destruction and dissection. The spinal cord in the vulnerable watershed zone of T12-L1 downwards revealed ischemic softening. No infarcts were seen in other organs as he succumbed rapidly to cardiac tamponade. Acute aortic dissection presenting as paraplegia though rare, should be considered in patients presenting with sudden onset paraplegia with associated severe pain and absent pulses. Prompt diagnosis and timely intervention may help save life and limb.     

Paraplegia due to Acute Aortic Coarctation and Occlusion

Coarctation and occlusion of the aorta is a rare condition that typically presents with hypertension or cardiac failure. However, neuropathy or myelopathy may be the presenting features of the condition when an intraspinal subarachnoid hemorrhage has compressed the spinal cord causing ischemia. We report two cases of middle-aged males who developed acute non-traumatic paraplegia. Undiagnosed congenital abnormalities, such as aortic coarctation and occlusion, should be considered for patients presenting with nontraumatic paraplegia in the absence of other identifiable causes. Our cases suggest that spinal cord ischemia resulting from acute spinal subarachnoid hemorrhage and can cause paraplegia, and that clinicians must carefully examine patients presenting with nontraumatic paraplegia because misdiagnosis can delay initiation of the appropriate treatment.     

脊髓血管畸形的临床特征研究

目的:分析研究脊髓血管畸形的临床特征。方法:收集６２例ＭＲＩ、ＤＳＡ和(或)手术病理证实的脊髓血管畸形患者。结果;髓内隐匿型ＡＶＭ无明显的性别差异,余各类型男性多于女性;髓周ＡＶＭ、髓内ＡＶＦ青少年多见,硬膜型ＡＶＦ多见中老年;髓内ＡＶＭ多位于颈髓及胸腰髓,ＡＶＦ多位于胸腰段区域;髓内ＡＶＭ急性起病多见,ＡＶＦ多慢性起病,进行性加重。结论:根据临床症状、起病特征可初步判断病变类型,争取早期正确诊断、早期治疗。     

Neurological symptoms in aortic dissection: a challenge for neurologists

Typically, aortic dissection has to be considered in patients with acute thoracic or abdominal pain and accompanying cardiovascular symptoms. Due to these clinical symptoms, neurologists have not been involved in the routine emergency management of aortic dissection. However, transient or permanent neurological symptoms at onset of aortic dissection are not only frequent (17-40% of the patients), but often dramatic and may mask the underlying condition. Especially in pain-free dissection (which occurs in 5-15%) with predominant neurological symptoms diagnosis of aortic dissection can be difficult and delayed. Affecting the outflow of supra-aortal, spinal as well as extremity arteries leads to a variety of neurological symptoms including disturbances of central or peripheral nervous system. Thrombolysis as an emergency stroke therapy without considering aortic dissection may be life-threatening for these patients. Routine chest X-ray and being alert to physical examination findings such as hypotension, asymmetrical pulses or cardiac murmur may reduce risk of delayed diagnosis or misdiagnosis. Neurological symptoms at onset or in the postoperative course of aortic dissection are not necessarily associated with increased mortality.     

Paraparesis as the major initial presentation of aortic dissection: report of four cases

Aortic dissection, which typically manifests as sudden tearing or migratory pain, is a well-known medical emergency. However, in 5% of aortic dissection patients, there is no pain. In these patients, the diagnosis depends on the development of neurologic complications. After analyzing the initial symptoms of a series of patients with aortic dissection, we found 4/211 (1.9%) patients suffered from paraparesis. We suggested that the mid- or low thoracic cord be most vulnerable site during acute aortic dissection. This report highlighted the importance of considering the diagnosis of aortic dissection in a patient with a history of acute onset of transient or permanent neurological symptoms in the lower limbs. Whether paraparesis can be an indicator of the prognosis of aortic dissection requires further researches.     

Early clinical signs and symptoms in occult spinal dysraphism: a retrospective case study of 47 patients.

Since occult spinal dysraphism can lead to irreversible neurological complications, early diagnosis and treatment are necessary. We retrospectively studied the presenting clinical signs and symptoms in all 47 cases of occult spinal dysraphism identified in two university hospitals in The Netherlands since 1965. Dermal sinus had been diagnosed in 12, lipomyelomeningocele in nine, and diastematomyelia in eight patients. Thirty-three patients had symptoms due to tethering of the spinal cord, leading to a clinical suspicion of occult spinal dysraphism in only eight cases. Twenty-eight patients had cutaneous back lesions that led to further investigation in eight cases. Nineteen patients had a small backmass leading to further examination in 13 cases. Three patients with dermal sinus presented with meningitis caused by an unusual aetiological agent. This study stresses the importance of identification of neurological dysfunction due to tethered cord syndrome, cutaneous back lesions, a small backmass and meningitis caused by an unusual aetiological agent for the early diagnosis of occult spinal dysraphism.     

Painless aortic dissection presenting as a progressive myelopathy

We report a patient with a painless aortic dissection whose neurologic symptoms progressed over 5 days to a complete transverse myelopathy. She did not experience pain as her neurologic deficits evolved. Magnetic resonance imaging revealed a thoracic aortic dissection extending from the arch to the level of the 12th thoracic vertebra and demonstrated ischemic changes in the spinal cord and one thoracic vertebral body. Aortic dissection must be included in the differential diagnosis of spinal cord syndromes even in the absence of pain. Early recognition of aortic dissection as a cause of progressive myelopathy may become increasingly important as new therapies for central nervous system ischemia are developed.     

32例颈髓肿瘤显微外科治疗研究

目的 探讨颈髓肿瘤的诊断、手术入路选择及手术操作技巧.方法 回顾性分析湘雅二院神经外科自2003年6月至2005年6月经手术治疗的32例颈髓肿瘤患者的临床资料.所有患者均经术前MRI确诊,经显微手术切除,术后均行MRI复查.结果 手术显微镜下全切肿瘤29例,大部分切除3例,其中2例为星形细胞瘤,1例为脂肪瘤.术后无神经功能障碍加重及死亡者.结论 MRI对颈髓肿瘤的诊断具有最重要的价值.据此可以明确肿瘤的大致类型、位置及毗邻关系.选择合适的手术入路.显微外科手术是治疗颈髓肿瘤的有效方法,熟练应用显微外科技术和手术操作技巧是治疗成功的关键因素.     

合并神经系统损害的主动脉夹层30例临床分析

目的探讨主动脉夹层(aortic dissection，AD)合并神经系统损害的病因、发病机制、临床特征及诊断要点，以提高对本病的认识。方法回顾性总结分析收治的符合AD临床诊断的30例合并神经系统损害患的临床资料，其中神经系统损害排除了既往史中其他神经系统疾病。结果本组30例患中以急性神经系统损害为首发症状9例，单纯神经系统损害2例，病程中伴有神经系统损害28例。结论对于合并有胸背痛、胸闷、血压不对称、脉搏短绌等症、征的神经系统损害的患要高度怀疑AD的可能，降低漏诊误诊率。