Roullet E, Netter J M, Chiras J, Mahieux F, Amarenco P, Marteau R
Service de Neurologie, Hôpital Saint-Antoine, Paris.
Rev Neurol (Paris). 1988;144(5):371-5.
Metrizamide dorsal myelography was performed in two patients with minor to moderate sensorimotor paraparesis. Direct and indirect myelographic signs of spinal arteriovenous aneurysm were seen and spinal cord angiography showed thoracic dural arteriovenous fistulae (AVF) in both cases. Within 24 hours following myelography, clear neurological worsening occurred, associated with cephalalgia, nausea and transient diplopia in one case, leading to paraplegia in a few days. Paraplegia was complete six months after surgery in one case, and had resolved after embolization of fistula in the other patient. The mechanism of neurological worsening may include: substraction of cerebrospinal fluid, sitting position during and after myelography and local increase of metrizamide concentration secondary to impaired resorption caused by the fistula. Water-soluble myelography is of invaluable aid in the diagnosis of dural AVF and must be followed by early angiography, thus allowing prompt therapeutic embolization.
对两名患有轻度至中度感觉运动性轻截瘫的患者进行了甲泛葡胺脊髓造影。观察到脊髓动静脉瘤的直接和间接脊髓造影征象，脊髓血管造影显示两例均为胸段硬脊膜动静脉瘘（AVF）。脊髓造影后24小时内，出现明显的神经功能恶化，其中1例伴有头痛、恶心和短暂性复视，数天后导致截瘫。1例患者术后6个月截瘫完全，另1例患者在瘘管栓塞后截瘫症状消失。神经功能恶化的机制可能包括：脑脊液减少、脊髓造影期间及之后的坐姿以及瘘管导致吸收受损继发甲泛葡胺浓度局部升高。水溶性脊髓造影对硬脊膜动静脉瘘的诊断有极大帮助，造影后必须尽早进行血管造影，以便及时进行治疗性栓塞。
