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病例报告

脊髓前壁梗死是一种罕见的破坏性疾病。下面的例子说明了这种情况:

一位40岁的手术室护士最近坐了一次长途飞机，凌晨2点醒来，抱怨背痛、胸痛和双下肢无力。然后她被送到了急诊室。她否认有头痛、口齿不清、视觉障碍、呼吸困难、尿或大便失禁。她没有既往病史，也没有服药。她没有明显的家族史，不吸烟。检查时，她所有的生命体征都很正常。她的GCS是15/15。听诊心音正常，无肿瘤，胸部清晰，胸部运动良好。她的腹部柔软无压痛。颅神经及上肢神经检查正常。 On examining her lower limbs, her tone was flaccid with absent knee and ankle reflexes bilaterally, power in both her lower limb were 0/5 , her sensation was markedly reduced from her xiphisternum to her toes. Her anal tone was also reduced. However her proprioception and vibration were still present in her lower limbs. Her plantar reflexes were upgoing bilaterally. Her ECG showed a normal sinus rhytm and her CXR was normal. FBC, U&E, CRP, LFT, Troponin, D-Dimer were all normal. CT aortogram and MRI brain done was normal but unfortunately MRI of her spine confirmed an ASA infarct. She was started on high dose aspirin and transferred to a tertiary neurological centre for continuation of care.

ASA梗死典型表现为运动功能和疼痛/温度感觉的丧失，损伤水平以下的本体感觉和振动感觉相对保留。急性期的特点是松弛和丧失深腱反射;随后几天或几周出现痉挛和反射亢进。可能存在自主神经功能障碍，表现为低血压(无论是直立性低血压或明显低血压)，性功能障碍，和/或肠和膀胱功能障碍。据报道，一例C7至T1脊髓梗死患者出现胸痛伴心电图改变。在对病人的急性评估中，重要的是要认识到低血压可能是脊髓缺血的原因和表现。如果病变位于颈索吻侧，呼吸就会受到影响。多种疾病都可能导致脊髓梗死。其机制可分为胸腹主动脉疾病或手术，固有动脉闭塞(由动脉硬化、血管炎、感染、栓塞闭塞、血栓形成引起)，低灌注和静脉梗死。预后不良的恢复因素包括严重损害的表现、女性、高龄和[1]前24小时无改善。

鉴于此病例，临床检查显示背柱功能的保留是帮助获得正确诊断的主要指导。

参考文献

• 1.http://www.uptodate.com/contents/spinal-cord-infarction-clinical-presentation-and-diagnosis