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[脊髓型颈椎病中的“假性多发性神经病”型感觉障碍]

[The "pseudo-polyneuropathy" type sensory disturbances in cervical spondylotic myelopathy].

作者信息

Yoshiyama Y, Tokumaru Y, Hattori T, Hirayama K

机构信息

Department of Neurology, School of Medicine, Chiba University.

出版信息

Rinsho Shinkeigaku. 1995 Feb;35(2):141-6.

PMID:7781229
Abstract

We reported the pseudo-polyneuropathy type sensory disturbances in cervical spondylotic myelopathy. We defined this clinical type by objective superficial sensory deficits of all four distal limbs, and excluded the patients having only subjective sensory disturbances. Ten out of 61 patients with cervical spondylotic myelopathy had sensory disturbances of this type. Two patients noticed difference of the subjective sensations of the upper and lower limbs. Eight patients developed sensory symptoms initially in the upper limbs. Pin-prick sensation was diminished in the upper limbs more predominantly than in the lower limbs. Vibration sense was affected in the lower limbs predominantly. Motor functions were mildly impaired, and muscle stretch reflex of triceps brachii was preserved in all ten patients. Distribution of sensory disturbances of four patients changed in their course. Nerve conduction studies and F-wave latencies were normal. Electromyography showed mild chronic denervation of the C5-C7 innervated muscles. Somatosensory evoked potentials after median or ulnar nerve stimulation showed delayed latencies or attenuated waveforms of N13 as well as P14 peaks. Spinal cord was compressed mainly at C4/5 and C5/6 intervertebral level, shown by myelography, CT-myelography or magnetic resonance imagings. We conclude that the pseudo-polyneuropathy type sensory disturbance of cervical spondylotic myelopathy indicates the lesion at mid-to-low cervical vertebral level. The anatomical substrates for this type of sensory impairment could be caused by combination of the dorsal horn/anterior comissure lesions for the upper limbs, and the anterolateral funiculi lesions for the lower limbs.

摘要

我们报告了脊髓型颈椎病中的假性多发性神经病型感觉障碍。我们通过四肢远端客观的浅感觉缺失来定义这种临床类型,并排除仅有主观感觉障碍的患者。61例脊髓型颈椎病患者中有10例出现了这种类型的感觉障碍。2例患者注意到上下肢主观感觉的差异。8例患者最初在上肢出现感觉症状。上肢针刺觉减退比下肢更明显。下肢振动觉受累为主。运动功能轻度受损,10例患者肱三头肌的肌肉牵张反射均保留。4例患者感觉障碍的分布在病程中发生了变化。神经传导研究和F波潜伏期正常。肌电图显示C5 - C7支配肌肉有轻度慢性失神经改变。正中神经或尺神经刺激后的体感诱发电位显示N13以及P14峰潜伏期延迟或波形衰减。脊髓造影、CT脊髓造影或磁共振成像显示脊髓主要在C4/5和C5/6椎间水平受压。我们得出结论,脊髓型颈椎病的假性多发性神经病型感觉障碍提示中低位颈椎水平的病变。这种类型感觉障碍的解剖学基础可能是上肢背角/前连合病变与下肢前外侧索病变共同作用的结果。

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