Devesa A, Sáez-Pérez J M, Sánchez-Roy R, Torres-García J, Simó C
Hospital Arnau de Vilanova, Valencia, España.
Rev Neurol. 1999;28(9):878-80.
Ischemic spinal cord infarct is the most frequent vascular lesion, but although aortic aneurysms are a possible cause, it is unusual for such cases to be seen. Clinical case. We present a case of spinal ischemia as the first sign of the dissection of an aneurysm of the abdominal aorta. A 58 year old man was seen in the hospital Emergency Department complaining of lumbar pain and the sudden onset of paraplegia of the legs, associated with pain in the middle of his back but with no history of previous trauma or effort. The only relevant personal history was of smoking. Whilst he was in the Neurology Department, the anomaly was diagnosed after dorsal, and lumbar gadolinium magnetic resonance (MR), when a zone of ischaemia at T9-T10 was seen and, as a casual observation, an image compatible with an aneurysm of the abdominal aorta. The relationship between the dissection of the aorta and the neurological complications may be explained by a clear understanding of the vascular supply to the spinal cord. In this case, both the clinical findings and the MR were clearly indicative of an anterior spinal artery syndrome.
In spite of its rarity, aortic aneurysm should be included in the differential diagnosis of a clinical picture of ischemic myelopathy, especially when there is lumbar and/or abdominal pain before the appearance of neurological symptoms. Spinal MR is important for this diagnosis.
缺血性脊髓梗死是最常见的血管性病变，尽管主动脉瘤是其可能病因，但此类病例并不常见。临床病例。我们报告一例脊髓缺血作为腹主动脉瘤夹层分离首发症状的病例。一名58岁男性因腰痛及双下肢突然截瘫就诊于医院急诊科，伴有背部中部疼痛，既往无外伤或用力史。唯一相关个人史为吸烟。在神经科就诊时，经胸段和腰段钆增强磁共振成像（MR）检查后诊断出异常，发现T9 - T10节段存在缺血区，偶然观察到与腹主动脉瘤相符的影像。主动脉夹层分离与神经并发症之间的关系可通过对脊髓血供的清晰了解来解释。在本病例中，临床症状和MR均明确提示为脊髓前动脉综合征。
尽管罕见，但在缺血性脊髓病临床表现的鉴别诊断中应考虑主动脉瘤，尤其是在神经症状出现前有腰痛和/或腹痛时。脊髓MR对该诊断很重要。
