anterior spinal artery syndrome
Introduction
Introduction to the anterior spinal artery syndrome Anteriorspinalarteria syndrome (also known as Beck syndrome, Davison syndrome, anterior spinal artery occlusion syndrome, etc.). The clinical features of this disease are the distribution of the anterior spinal artery, causing paralysis of the limbs, pain, temperature, and rectal bladder sphincter. The anterior spinal artery supplies blood to the ventral 2/3 region of the spinal cord. When the blood vessels are occluded, the spinal cord is caused. Damage to the lateral and lateral cords. basic knowledge Sickness ratio: 0.001%-0.002% Susceptible people: no specific population Mode of infection: non-infectious Complications: pneumonia, acne, urinary tract infection
Cause
Cause of spinal cord anterior artery syndrome
Virus infection (30%):
Spinal cord anterior arterial thrombosis, which is associated with infection in young patients, viral and bacterial toxins cause wall damage, further thrombosis, acute suppurative meningitis, tuberculous meningitis, spinal vascular malformations, nodular arteritis, and Syphilis infection can be complicated by this disease, and elderly patients are mostly caused by spinal atherosclerosis.
Anatomical factors (30%):
It can be seen by the naked eye that the ventral and lateral sides of the spinal cord are softened and shrunk and the color is lightened. In the early part of the spinal cord, congestion and edema may occur in one part or several segments. In the same patient, the softening area of each segment is not consistent, because each The segmental circulation of the segments is different and the local vascular anatomy is different. The softened area has a typical infarct change.
Prevention
Prevention of anterior spinal artery syndrome
If it is to prevent infection and arteriosclerosis and other primary diseases. In the early stage, special attention should be paid to prevent complications such as hemorrhoids, hypostatic pneumonia and cystitis.
1. Usually avoid excessive incentives such as overwork, oversaturation and cold.
2. Adrenalin, insulin, hormone drugs should be used with caution or disabled.
3. Frequent seizures should limit salt intake, and can take potassium chloride or spiral lactone to prevent seizures.
Complication
Complications of anterior spinal cord syndrome Complications pneumonia acne urinary tract infection
Secondary pneumonia, hemorrhoids, urinary tract infections, etc. caused by progressive paraplegia. Persistent muscle weakness can occur, even muscle atrophy. Individual patients still have arrhythmia during the intermittent period, often dying of ventricular tachycardia. Chest tightness, palpitations, difficulty breathing, slow heartbeat, arrhythmia, dysuria, chewing weakness, eating cough, difficulty swallowing, unclear speech, etc. may also occur due to paralysis of the diaphragm, respiratory muscles, and myocardium.
Symptom
Symptoms of anterior spinal cord syndrome Common symptoms Quadriplegia, urinary incontinence, nutritional disorders, Tongue muscle atrophy, Paraplegia, Sensory disturbance, Separation of spinal cord shock, Paralysis
The incidence is more rapid, often the symptoms develop to a peak within a few hours to several days, the disease often has root pain or numbness, suggesting the upper boundary of the lesion, the common lesion area is mostly in the neck or thoracic spinal cord, followed by the lumbar region, located in the medulla oblongata Rare. Root pain is located in the neck or shoulder. If the neck is inflated, the root pain is in the upper limbs, followed by atrophy of the hand muscles. After the spinal cord is damaged, quadriplegia occurs. The initial flaccid "spinal shock" gradually becomes paralyzed. In the early stage, the characteristics of dysfunction and sensory separation were characteristic changes, pain and temperature were lost, and vibratory and positional sensations existed. After the collateral circulation was established, the sensory disturbance was quickly improved. The root pain was several days after the appearance of sputum. It still does not disappear in a few weeks.
Examine
Examination of anterior spinal cord syndrome
1. Cerebrospinal fluid examination: The lumbar puncture of the spinal canal is generally free of obstruction. The appearance of CSF is colorless, transparent or yellow, and the number of cells is normal. Sometimes the protein content is normal or slightly increased, and the number of cells is normal.
2. Other optional examination items include: blood electrolytes, blood glucose, urea nitrogen, and carcinoembryonic antigen tests.
3. MRI manifestations: acute spinal cord thickening, swelling, low signal on T1WI, high signal on T2WI, markedly enhanced lesions 1 to 3 weeks after onset, and spinal cord atrophy in chronic phase.
Diagnosis
Diagnosis and differentiation of anterior spinal artery syndrome
Generally, according to the characteristics of medical history, the onset is rapid, and it is a transverse spinal cord injury. It often does not involve positional awareness. The spinal canal is not obstructed. It is not difficult to confirm the diagnosis. However, the cause of this disease is often not easy to be determined. Young patients are more concerned with infection or trauma. May be related to spinal atheroma.
Differential diagnosis
It should be identified with the following diseases:
1. Acute infectious myelitis: This disease is more common in young adults. It may have a history of infection such as fever before the disease. Most of them are complete spinal cord transverse damage. Sometimes it can also be expressed as anterior spinal artery syndrome. The initial cerebrospinal fluid is often light. Increased white blood cells.
2. Spinal cord hemorrhagic disease: a history of trauma, characterized by sudden onset of illness, accompanied by severe back pain at the onset of the disease, severe spinal cord traverse damage after several minutes to several hours, a large number of bleeding can be worn The soft meninges make the cerebrospinal fluid examination bloody, and the spinal imaging examination has changes such as traumatic spinal dislocation, which is more conducive to diagnosis. If the intraspinal hemorrhage caused by blood disease or spinal vascular malformation, hematology or myelography should be used to confirm diagnosis.
