脊髓亚急性联合变性15例临床分析

目的　总结脊髓亚急性联合变性的临床特点 ,探讨该病的病因、电生理及其MRI表现。方法　对 15例脊髓亚急性联合变性的临床表现 ,实验室、电生理及MRI检查、常见病因、治疗方法进行了分析。结果　 15例均有后索、侧索及周围神经损害 ,以后索、侧索损害为主者 11例 (73 .3 3 % ) ,以周围神经损害为主者 4例 (2 6.67% ) ,伴精神症状者 3例 (2 0 % ) ,伴视力减退者 4例 (2 6.67% )。检测血清维生素B1 2 11例 ,其中降低 8例 (72 .73 % )、正常 3例 (2 7.2 7% )。MRI检查脊髓异常 2例 ,均为脊髓后索长条状对称性的等 (或 )长T1、长T2信号。结论　脊髓亚急性联合变性是由于维生素B1 2 缺乏以后索、侧索及周围神经损害为主的疾病 ,血清维生素B1 2 降低有助于脊髓亚急性联合变性的诊断 ,但不是一个绝对可靠的指标。脊髓MRI检查对本病具有客观诊断价值。

Clinical Analysis of Subacute Combined Degeneration of Spinal Cord

Objective To describe the clinical features of subacute combined degeneration (SCD) of spinal cord and research the common causes, electrophysiology and magnetic resonance imaging (MRI) features.Methods Fifteen cases of spinal cord SCD were reported. The clinical features, laboratory tests, electrophysiology, MRI, common causes, therapy, and the progress in the study of SCD were also analyzed. Results All patients had lesions in dorsal columns, lateral columns and peripheral nerves, and 11 of them (73.33%) had their lesions mainly in dorsal and lateral columns, and the others (26.67%) mainly in peripheral nerves. There were three patients accompanied by mental symptoms and four ones by reducing visual acuity. Eleven patients were measured serum vitamin B 12 level, 8 of whom (72.73%) were found low serum vitamin B 12 level, and three (27.27%) were normal level. Two patients had abnormal features of MRI, showed equal or long signal in density in the two dorsal columns of spinal cord.Conclusion SCD of spinal cord is a disease caused by vitamin B 12 deficiency and its main lesions are located in dorsal columns, lateral columns and peripheral nerves. Low serum vitamin B 12 level helps to diagnose SCD, but the diagnostic significance of serum vitamin B 12 level to SCD should further be studied. MRI findings correspond with demyelination of the dorsal columns and lateral columns of the spinal cord in SCD.