Department of Neurology, Hiratsuka Kyosai Hospital, Hiratsuka, Japan.
J Neurol Sci. 2013 Jan 15;324(1-2):195-6. doi: 10.1016/j.jns.2012.11.005. Epub 2012 Nov 29.
Cervical angina is defined as chest pain resembling true cardiac angina but originating from disorders of the cervical spine. Cervical angina is caused by cervical spondylosis in most cases. A 66-year-old man presented with bilateral arm palsy after chest pain resembling angina pectoris. Neurological examination revealed motor and sensory disturbances of the C7 to T1 level, and magnetic resonance imaging showed a hyperintense spinal cord lesion on T2-weighted imaging. Spinal cord infarction was diagnosed. Severe sinus bradycardia was identified on admission, and improved over the course of 5 weeks. Sympathetic afferent fibers from the heart and coronary arteries generally have their cell bodies in the dorsal root ganglia of the C8 to T9 spinal segments. Electrical stimulation of cardiopulmonary afferent fibers excites spinothalamic tract cells in the T1 to T6 segments of the spinal cord. Spinal cord injury can result in the loss of supraspinal control of the sympathetic system and can cause bradycardia, as commonly seen in patients with severe lesions of the cervical or high-thoracic (T6 or above) spinal cord. Bradycardia in the present case suggested impairment of the sympathetic system at the cervical and thoracic levels. These findings indicated that cervical angina in this case was mediated through the sympathetic nervous system. This represents only the second report of cervical angina caused by spinal cord infarction.
颈源性心绞痛定义为类似于真性心绞痛的胸痛，但起源于颈椎疾病。颈源性心绞痛在大多数情况下由颈椎病引起。一名 66 岁男性在出现类似心绞痛的胸痛后出现双侧手臂瘫痪。神经系统检查显示 C7 至 T1 水平的运动和感觉障碍，磁共振成像显示 T2 加权成像上脊髓高信号病变。诊断为脊髓梗死。入院时发现严重窦性心动过缓，在 5 周内逐渐改善。来自心脏和冠状动脉的交感传入纤维通常在 C8 到 T9 脊髓节段的背根神经节中有其细胞体。心肺传入纤维的电刺激兴奋脊髓 T1 到 T6 节段的脊髓丘脑束细胞。脊髓损伤可导致交感神经系统失去上位控制，并可导致心动过缓，如常见于严重颈段或高胸段（T6 或以上）脊髓损伤的患者。本例中的心动过缓提示颈胸段交感神经系统受损。这些发现表明，本例中的颈源性心绞痛是通过交感神经系统介导的。这是脊髓梗死引起颈源性心绞痛的第二例报告。
