Department of Neurology, Massachusetts General Hospital and Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Neurosurgery, Tufts University School of Medicine, Boston, MA 02111, USA.
Neurol Clin. 2021 May;39(2):489-512. doi: 10.1016/j.ncl.2021.01.011.
Vascular and infectious causes are rare but important causes of spinal cord injury. High suspicion for these processes is necessary, as symptoms may progress over hours to days, resulting in delayed presentation and diagnosis and worse outcomes. History and clinical examination findings can assist with localization of the affected vascular territory and spinal level, which will assist with focusing spinal imaging. Open and/or endovascular surgical management depends on the associated vascular abnormality. Infectious myelopathy treatment consists of targeted antimicrobial therapy when possible, infectious source control, and again, close monitoring for systemic complications.
血管性和感染性病因少见但很重要,也可导致脊髓损伤。对于这些病因需保持高度警惕,因为其症状可能在数小时至数天内进展,导致就诊和诊断延迟,从而使预后变差。病史和临床检查结果有助于确定受累血管区域和脊髓节段,从而有助于确定脊髓影像学检查的重点。开放性和(或)血管内手术治疗取决于相关的血管异常。对于感染性脊髓病,如有可能,治疗包括针对特定病原体的抗菌治疗、感染源控制,同样需要密切监测全身并发症。