Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Rd, Hammersmith, London, W6 8RF, UK.
Department of Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
BMC Neurol. 2019 Oct 30;19(1):262. doi: 10.1186/s12883-019-1487-z.
Failing to recognise the signs and symptoms of subarachnoid haemorrhage (SAH) causes diagnostic delay and may result in poorer outcomes. We report a rare case of SAH secondary to a vertebral artery dissection (VAD) that initially presented with cauda equina-like features, followed by symptoms more typical of SAH.
A 55-year-old man developed severe lower back pain after sudden movement. Over the next 5 days he developed paraesthesiaes in the feet, progressing to the torso gradually, and reported constipation and reduced sensation when passing urine. On day six he developed left facial palsy, and later gradual-onset headache and intermittent confusion. Magnetic resonance imaging of the brain showed diffuse subarachnoid FLAIR hyperintensity, concerning for blood, including a focus of cortical/subcortical high signal in the left superior parietal lobule, which was confirmed by computed tomography. Digital subtraction angiography demonstrated a left VAD with a fusiform aneurysm.
We present a very rare case of intracranial VAD with SAH initially presenting with spinal symptoms. The majority of subsequent clinical features were consistent with a parietal focus of cortical subarachnoid blood, as observed on neuroimaging.
未能识别蛛网膜下腔出血 (SAH) 的体征和症状会导致诊断延迟，并可能导致更差的结果。我们报告了一例罕见的椎动脉夹层 (VAD) 引起的 SAH 病例，该病例最初表现为马尾综合征样特征，随后出现更典型的 SAH 症状。
一名 55 岁男性在突然运动后出现严重的下腰痛。在接下来的 5 天里，他的脚部出现了感觉异常，逐渐发展到躯干，并报告说便秘和排尿时感觉减弱。第 6 天，他出现左侧面瘫，随后逐渐出现头痛和间歇性意识模糊。脑部磁共振成像显示弥漫性蛛网膜下腔 FLAIR 高信号，提示有血液，包括左顶叶皮质/皮质下高信号焦点，计算机断层扫描证实了这一点。数字减影血管造影显示左侧 VAD 伴梭形动脉瘤。
我们报告了一例非常罕见的颅内 VAD 伴 SAH 病例，最初表现为脊髓症状。随后的大多数临床特征与神经影像学观察到的顶叶皮质下蛛网膜下腔血液的局灶性一致。
