Geroldi C, Frisoni G B, Bianchetti A, Trabucchi M, Bricolo A
Alzheimer's Unit, IRCCS S. Giovanni di Dio, Sacro Cuore Fatebenefratelli Hospital, Brescia, Italy.
Age Ageing. 1999 Jul;28(4):399-400. doi: 10.1093/ageing/28.4.399.
A 76-year-old woman, complaining of leg pain and unsteady gait for 3 years, presented with a spastic paraparetic gait, severe spasticity and touch, thermal and pain sensory loss limited to arms, lower thorax and upper abdomen. Brain and spinal cord magnetic resonance imaging showed a large loculated syrinx. Cerebellar tonsillar herniation into the foramen magnum was also seen (Arnold-Chiari malformation, type I).
The patient had successful cervico-spinal surgical decompression which resulted in marked reduction in hypertonia and weakness, normal gait and normal joint movement at 6 months.
This unusual, late clinical presentation of a congenital disease underlines the importance of a comprehensive diagnostic work-up in the elderly patients with complex neurological signs.
一名76岁女性，主诉腿部疼痛和步态不稳3年，出现痉挛性截瘫步态、严重痉挛，且触觉、温度觉和痛觉丧失仅限于手臂、下胸部和上腹部。脑和脊髓磁共振成像显示一个大的分叶状空洞。还可见小脑扁桃体疝入枕骨大孔（I型阿诺德-奇亚里畸形）。
患者接受了成功的颈脊髓手术减压，6个月时肌张力亢进和无力明显减轻，步态正常，关节活动正常。
这种先天性疾病不寻常的晚期临床表现凸显了对有复杂神经体征的老年患者进行全面诊断检查的重要性。
