摘要
目的通过对3例胸段脊髓硬脊膜动静脉瘘(SDAVF)的病例报道,分析该病的临床特征、影像学特点,提高临床医生对SDAVF的认识和诊断水平,减少误诊误治。方法收集3例SDAVF患者的临床资料,对其病史特点、临床特征、脊髓MRI和DSA进行分析。结果 3例患者平均年龄48岁,慢性病程,缓慢进展,表现为下肢运动障碍、深浅感觉障碍、大小便障碍,病初具有波动性,脊髓MRI可见脊髓轻度肿胀增粗和髓内异常信号灶,斑片状轻度强化,脊髓前后有迂曲匍行血管流空影,全部患者经脊髓血管造影明确诊断,经介入栓塞或手术治疗症状均得到改善;糖皮质激素治疗会导致症状恶化。结论 SDAVF以中年多见,缓慢进展,特征表现为波动性下肢无力及小便障碍,极易误诊,脊髓前后迂曲匍行血管流空影是特异性表现,脊髓血管造影是诊断本病的金标准,及早确诊介入栓塞或手术治疗能取得较好疗效,避免残疾。
Objective To advance the knowledge and understanding of Spinal Dural Arteriovenous Fistula(SDAVF)of the clinicians,improve their performance,and lower the misdiagnosis rate,we hereto studied the clinical characteristics and morphological features of the disease through careful analysis of the diagnosis reports of three patients with SDAVF.Methods We attentively studied the medical history of these patients,the clinical features,MRI of the spines,and DSA based on clinical data collected from the patients.Results The average age of the patients was 48 years.The clinical course was slowly progressive,characterized by lower extremity dyskinesia,sensory loss,dysfunction of bowel and bladder and high odds of recurrence at an early stage of development.Spinal cord MRI showed mild swelling of the spinal cord and abnormal intramedullary signal intensity.Clumped segmental enhancements and abnormal tortuous vessels with characteristic signal voids in the anterior and posterior spinal cord were also spotted.All patients were diagnosed by spinal angiography,and the symptoms alleviated after embolization or surgery.Glucocorticoid treatment,though,would aggravate those symptoms.Conclusion SDAVF is much common in middle aged people and often is slowly progressive.It is characterized by fluctuating lower extremity dyskinesia and bladder dysfunction and is usually easily misdiagnosed.Spinal angiography is considered to be the most useful diagnostic method.The prognostic outcomes can be good if diagnosed and treated at an early stage of development.
作者
李东岳
牛敬忠
郭红燕
石丽君
张金涛
LI Dongyue;NIU Jingzhong;GUO Hongyan;SHI Lijun;ZHANG Jintao(Tai'an Hospital District,960th Hospital of PLA,Tai'an 271000,China;Affiliated Hospital of Taishan Medical University,Tai'an 271000,China)
出处
《中国实用神经疾病杂志》
2019年第1期72-76,共5页
Chinese Journal of Practical Nervous Diseases
