脑脊液引流及血压升高治疗急性脊髓梗死
Cerebrospinal fluid drainage and blood pressure elevation to treat acute spinal cord infarct.
作者信息
Strohm Tamara A, John Seby, Hussain Muhammad S
机构信息
Department of Neurology, Cleveland Clinic, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
出版信息
Surg Neurol Int. 2018 Sep 21;9:195. doi: 10.4103/sni.sni_2_18. eCollection 2018.
BACKGROUND
Current management of acute spinal cord infarction (SCI) is limited. Lumbar cerebrospinal fluid drainage (CSFD) with blood pressure augmentation is utilized in the thoracic/thoracoabdominal aortic repair and thoracic endovascular aortic repair (TEVAR) populations to increase spinal perfusion pressure.
CASE DESCRIPTION
We identified 3 patients who sustained acute SCI and underwent CSFD and maintenance of elevated mean arterial pressure (MAP) within 24 hours of injury. The first patient exhibited delayed-onset ischemia after a TEVAR. The second patient presented with an acute type B aortic intramural hematoma. The third patient developed spinal cord ischemia following bronchial artery embolization. There was significant improvement in the motor examination (e.g., ASIA impairment scale grade B or C) to grade D utilizing both blood pressure augmentation and CSFD.
CONCLUSIONS
Lumbar CSFD with MAP elevation benefited 3 patients with acute SCI of varying etiologies.
背景
目前急性脊髓梗死（SCI）的治疗方法有限。在胸段/胸腹主动脉修复术和胸段血管腔内主动脉修复术（TEVAR）患者中，采用腰椎脑脊液引流（CSFD）并提高血压，以增加脊髓灌注压。
病例描述
我们确定了3例发生急性脊髓损伤并在受伤后24小时内接受CSFD和维持平均动脉压（MAP）升高的患者。首例患者在TEVAR术后出现迟发性缺血。第二例患者表现为急性B型主动脉壁内血肿。第三例患者在支气管动脉栓塞后发生脊髓缺血。通过提高血压和CSFD，运动检查（如美国脊髓损伤协会损伤分级为B级或C级）有显著改善，达到了D级。
结论
腰椎CSFD联合MAP升高使3例病因各异的急性脊髓损伤患者受益。
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