双语病例——脊髓前动脉综合征
朗读老师及翻译老师：周艺庭 呼和浩特市第一医院
History: A 37-year-old woman presented to the emergency department with acute onset of lower extremity weakness, low back pain, and urinary retention.
病史：37岁女性突发下肢无力、下背部疼痛、排尿困难，于急诊就诊
A complete spine MRI exam was performed. Select images are shown below. In order: sagittal T1-weighted fluid-attenuated inversion-recovery (FLAIR), sagittal T2-weighted, sagittal short tau inversion-recovery (STIR), and axial T2-weighted images. Click images to enlarge.
患者进行了完整的脊柱MRI检查。
部分图像如下所示，依次为:矢状位T1WI加权、 FLAIR、矢状位T2WI加权、STIR和轴位T2WI加权。点击图片放大。
Postcontrast images also were obtained. Shown below are a sagittal T1-weighted postcontrast and two axial T1-weighted volumetric interpolated breath-hold examination (VIBE) postcontrast images. Click images to enlarge.
增强图像：下图为矢状位T1WI加权增强图和两张轴位T1WI加权、 (VIBE)增强图。点击图片放大。
Findings
MRI shows the following:
Increased T2 signal and mild enhancement of the conus medullaris
Mild expansion of the conus medullaris
Enhancement of the ventral greater than dorsal roots of the cauda equina
Increased T2 signal in the posterior aspect of lower thoracic vertebral bodies with associated mild enhancement
影像表现，MRI示：
1、T2WI见脊髓圆锥信号增高并轻度强化；
2、脊髓圆锥轻度扩张
3、马尾腹侧强化程度高于背侧根侧
4、增强扫描见下位胸椎椎体后侧T2信号增高，伴轻度强化
Differential diagnosis
Spinal infarction
Guillain-Barré syndrome
Transverse myelitis
Neurosarcoidosis
Multiple sclerosis/acute disseminated encephalomyelitis (ADEM)
Diagnosis: Anterior spinal infarction
鉴别诊断:
1、脊髓梗死
2、格林巴利综合征
3、横贯性脊髓炎
4、神经系统结节病
5、多发性硬化/急性播散性脑脊髓炎(ADEM)
诊断:脊髓前动脉梗死
Discussion
Anterior spinal artery infarction/syndrome
Pathophysiology
The anterior spinal artery originates from branches of the vertebral arteries.
The artery of Adamkiewicz, which typically arises from the left aorta, is an additional important supplier of the anterior spinal artery in the lumbar and sacral regions.
Occlusion of or injury to the anterior spinal artery results in damage to the anterior spinal cord, including the corticospinal and spinothalamic tracts.
讨论：脊髓前动脉梗死/综合征
病理生理：
1、脊髓前动脉起源于椎动脉分支。
2、亚当凯维奇动脉通常起源于左主动脉，是腰椎和骶椎脊髓前动脉的另一个重要供给者。
3、脊髓前动脉的栓塞或损伤导致脊髓前损伤，包括皮质脊髓和脊髓丘脑束。
Epidemiology
In children, anterior spinal artery infarction is related to cardiac malformations and trauma.
In adults, it is primarilyy related to atherosclerotic disease. It is also associated with thoracoabdominal aneurysms, aortic surgery, emboli, dissection, systemic hypotension, arteriovenous malformations, coagulopathies, and cocaine use.
流行病学：
1、在儿童中，脊髓前动脉梗死与心脏畸形和创伤有关。
2、在成年人中，它主要与动脉粥样硬化疾病有关。它还与胸腹动脉瘤、主动脉手术、栓塞、夹层、全身性低血压、动静脉畸形、凝血功能障碍和可卡因使用有关。
Clinical presentation
The condition is most often acute in onset, with symptoms worsening over several hours to a day.
Patients present with a loss of motor function (corticospinal tract) and pain/temperature sensation (spinothalamic tract) at and below the level of the injury.
Paralysis is flaccid at first with reduced deep tendon reflexes with later onset of spastic paralysis and hyperreflexia.
Patients may also present with bowel and bladder dysfunction and sexual dysfunction.
临床表现
1、该病最常在发病时出现急性症状，症状在数小时至一天内不断恶化。
2、患者表现为在损伤水平及以下的运动功能(皮质脊髓束)和疼痛/温度感觉(脊髓丘脑束)的丧失。
3、瘫痪最初表现为松弛，深腱反射减弱，随后发作痉挛性瘫痪和反射亢进。
4、患者还可出现肠、膀胱功能障碍和性功能障碍。
Imaging features
MRI may demonstrate the following:
Restricted diffusion and T2 hyperintensity in the ventral/anterior spinal cord
Cord expansion
T1 shortening, which may reflect hemorrhagic transformation
Enhancement of the infarct in the acute phase
Signal abnormality and enhancement along the posterior vertebral bodies
影像学特征
MRI可能表现如下:
1、脊髓前/腹侧弥散受限，T2高信号
2、脊髓扩张
3、T1信号缩短，可能反映出出血性转化
4、急性期梗死强化
5、信号异常，椎体后部强化
Differential diagnosis
Guillain-Barré syndrome
Transverse myelitis
Arachnoiditis
Neurosarcoidosis
Multiple sclerosis/ADEM
鉴别诊断
1、格林巴利综合征
2、横贯型脊髓炎
3、蛛网膜炎
4、神经系统结节病
5、多发性硬化症/ADEM
Treatment and prognosis
Evidence for specific treatments in spinal infarction is lacking. There is minimal evidence for thrombolysis.
Most treatments are supportive and focus on the systemic complications of spinal cord dysfunction.
Up to 20% of patients will die.
治疗和预后
1、缺乏脊柱梗死的具体治疗方法的证据。溶栓作用的证据微乎其微。
2、大多数治疗是支持性的，重点是脊髓功能障碍的全身性并发症。
3、多达20%的患者将会死亡。