Anterior central spinal artery ischemia syndrome
Introduction
Introduction of the anterior central nervous system ischemic syndrome More common in the lower neck, followed by the chest. The symptoms are mainly due to the symptoms of spinal cord injury caused by the complete or partial obstruction of the blood supply to the anterior central artery of the spinal cord. The incidence of cervical swelling is more common. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications:
Cause
Causes of anterior central nervous system ischemic syndrome
(1) Causes of the disease
The disease can occur due to the bone spur in front of the spinal canal or the direct compression of the intervertebral disc or the sudden flexion of the cervical vertebra on this basis.
(two) pathogenesis
Cervical vertebrae
Generally, in the case of a spur or a prominent intervertebral disc at the posterior edge of the vertebral body, when the cervical vertebra suddenly bends forward (in the case of trauma), a pair of violent violence is formed between the posterior wall of the dural sac and the frontal pressure, causing the central front of the spinal cord. The artery is damaged or stressed, and symptoms are caused by blocked blood flow.
2. Direct compression of bone spurs or intervertebral discs
This situation is mainly found in the narrow sagittal diameter of the spinal canal. As the spur grows or the nucleus increases, the anterior central artery of the spinal cord will be compressed and the blood flow will be poor. Cervical vertebrae are good, intervertebral disc compression is good in the neck and thoracic segment, especially the sagittal diameter of the thoracic spine is narrow, once the nucleus pulposus has a posterior process, the incidence is higher.
3. Vascular disease itself
Such neurology or cardiovascular diseases are not uncommon, especially in elderly and poor cardiovascular function or atherosclerosis, more common in middle-aged and elderly patients, the incidence of which is mostly sudden, and the symptoms are obvious.
4. Tumor compression
It is also clinically more common, with the largest number of thoracic segments, followed by cervical vertebrae. In recent years, with the wide application of MRI and CTM technology, the diagnosis of this disease has become easier, thus improving the early diagnosis rate.
Prevention
Prevention of anterior central nervous system ischemic syndrome
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Anterior spinal cord arterial ischemia syndrome Complications
Often combined with the sputum below the lesion.
Symptom
Symptoms of anterior central nervous system ischemic syndrome common symptoms sensory disturbance spur formation
The symptoms are mainly due to the symptoms of spinal cord injury caused by the complete or partial obstruction of the blood supply to the anterior central artery of the spinal cord. The incidence of cervical swelling is more common, and the clinical manifestations are as follows:
Dyskinesia
When the anterior central artery of the spinal cord is completely obstructed, it supplies softness to the lower part of the lesion because it supplies 2/3 of the front part of the spinal cord. If it occurs in the neck, it is generally lower than the upper limb. This is due to the conduction beam distributed in the lower limb. More superficial, some of the blockers showed weak muscle strength.
2. Sensory disorder
Mainly for the temperature and pain perception below the lesion disappeared or weakened, but the deep feeling and recognition were mostly normal.
3. Reflection changes
Shallow reflexes disappeared in the lower part of the lesion, deep reflexes, and pathological reflexes; if there were sputum sputum or sputum, the pressure was heavier, and effective measures should be taken as soon as possible.
Examine
Examination of the anterior central nervous system ischemic syndrome
1. Imaging examination
X-ray plain film or CT, MRI and other images show that the sagittal diameter of the vertebral body is narrow, and the posterior margin of the vertebral body has nucleus pulposus or bone spur formation. In some cases, magnetic resonance imaging (MRS) can be used. Spinal cord involvement.
2. Selective angiography
If the condition is available, the examination can find the location and extent of the obstruction, which is not only beneficial for diagnosis and differential diagnosis, but also plays an important role in the selection of the surgical site.
Diagnosis
Diagnosis and diagnosis of anterior central nervous system ischemic syndrome
Diagnostic criteria
1. History: There are many history of head and neck trauma or long-term flexion of the cervical spine, and attention to the presence or absence of spinal or cardiovascular diseases, etc., should be asked in detail.
2. Clinical features: The affected area is mainly sputum sputum, which may be accompanied by sensation separation signs. If the vascular involvement range is downward and the cone and the ponytail segment, it is flaccid paralysis.
3. Queer's test: simply due to vascular obstruction, generally no signs of obstruction.
4. Imaging examination: X-ray plain film or CT, MRI and other images often show that the sagittal diameter of the affected vertebrae is narrow, and the posterior margin of the vertebral body has nucleus pulposus detachment or spur formation. In some cases, spinal magnetic resonance imaging technology can be used. MRS), a comprehensive understanding of spinal cord involvement status.
5. Selective angiography: If the condition is feasible, the examination can find the location and extent of the obstruction, which is not only beneficial for diagnosis and differential diagnosis, but also plays an important role in the selection of the surgical site.
Differential diagnosis
Overextension injury
It is easy to differentiate from the anterior central artery injury based on the following characteristics:
(1) History of trauma: Head and neck suddenly stretched and injured.
(2) Features: The upper limb is heavier than the lower limb.
(3) Pre-vertebral shadow: significantly widened.
(4) X-ray film: see the front of the intervertebral space widened, the posterior edge of the vertebral body is generally more boneless.
2. Acute traumatic cervical or thoracic disc herniation
Acute traumatic cervical or thoracic disc herniation may be one of the causes of this disease, but it does not damage the anterior spinal artery but directly compresses the spinal cord and directly causes similar symptoms. In the latter case, the main image appears as The dyskinesia is mainly, and the sensation is abnormal, and the symptoms are fluctuating. After the traction, the nucleus can be clearly seen. The MRI image can clearly show the nucleus pulposus. However, the two are consistent in principle. Therefore, if the dysfunction is difficult, Need to be identified, early surgical treatment.
3. Intraspinal tumor
Tumors longer than the ventral thoracic spinal canal are more common, and the cervical segment can also be identified by MRI and myelography.
