spinal cord ischemia
Introduction
Introduction to spinal cord ischemia A series of damaging biochemical changes caused by spinal cord ischemia will lead to intracellular calcium accumulation, increased oxygen free radical content, thereby damaging neurons in the spinal cord, causing irreversible damage to the spinal cord. In the past ten years, due to the improvement of spinal vascular anatomy and blood flow measurement techniques, clinical understanding of spinal cord ischemia has progressed. Spinal cord ischemia is caused by many causes other than the spinal cord. The spinal cord itself has no pathological changes. Spinal cord ischemia can also be caused by vascular lesions such as spinal vascular malformation or spinal atherosclerosis. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: pneumonia, acne, urinary tract infection
Cause
Cause of spinal cord ischemia
(1) Causes of the disease
Spinal cord ischemia can occur in the blood supply of aortic angiography or aortic aneurysm, sometimes due to aortic atherosclerosis, spinal vascular malformations, microembolism, vasospasm and insufficient blood supply, other such as syphilitic spinal cord Arteritis, lumbar spinal stenosis, spinal cord trauma, polycythemia, venous thrombosis, and low blood pressure caused by systemic diseases can lead to spinal cord ischemia.
(two) pathogenesis
A series of invasive biochemical changes caused by spinal cord ischemia will lead to intracellular calcium accumulation, increased oxygen free radical content, thereby damaging neurons in the spinal cord, causing irreversible spinal cord dysfunction. Foreign scholars found in rabbit spinal cord ischemia model. Apoptotic bodies in damaged neurons suggest that apoptosis promotes neuronal cell death.
Prevention
Spinal ischemia prevention
1. The limbs should be passively exercised and massaged in the early stage to improve blood circulation, prevent hemorrhoids, turn over regularly, massage the pressed parts, and keep the skin clean.
2. Prevent respiratory infections and keep warm.
3. Early prevention and treatment can lead to diseases of spinal cord ischemia, such as spinal cord compression.
Complication
Spinal cord ischemia complications Complications pneumonia acne urinary tract infection
Mainly the primary manifestations of extra-spinal spinal cord, as well as secondary pneumonia caused by progressive paraplegia, hemorrhoids, urinary tract infections.
Symptom
Symptoms of spinal cord ischemia Common symptoms Sclerosing vascular malformation Cerebral ischemia Paraplegia Spinal anterior horn lesions Segmental dissociative sensory disturbance
Spinal cord ischemia is less common than cerebral ischemia. The main reasons are: spinal arteriosclerosis is less than cerebral arteries; spinal cord blood supply network is abundant; spinal cord has strong tolerance to ischemia, spinal cord ischemia caused by spinal cord disease itself, symptoms can be For the transient, it can also be permanent.
Transient cerebral ischemia is similar to transient ischemic attack. The seizure is sudden and lasts for no more than 24 hours. There is no sequelae after recovery. Intermittent claudication and distal paroxysmal weakness are the typical clinical manifestations of this disease. In the case of this "intermittent claudication" episode, the symptoms of the lower extremities may be inconsistent. Physical examination may reveal hyperreflexia of the knee and positive signs of pyramidal tract. However, there are still arterial pulsations, and the symptoms disappear and a few can also be expressed. For symptoms such as paroxysmal paraplegia.
After the spinal cord ischemia is gradually severe, it can also be progressive paraplegia, resulting in a sensory loss plane and sphincter disorders such as the bladder.
Examine
Spinal cord ischemia check
Cerebrospinal fluid examination
The lumbar puncture of the spinal canal is generally free of obstruction, or incomplete spinal canal obstruction, CSF appearance is colorless transparent or yellow, the number of cells is normal, sometimes the protein content is normal or slightly increased, and the number of cells is normal.
2. Other selective inspection items
Including blood electrolytes, blood sugar, urea nitrogen, carcinoembryonic antigen examination.
Spinal cord iodine angiography or visible spinal cord with amorphous stenosis, spinal magnetic resonance can also be used for diagnosis, MRI manifested as acute spinal cord thickening, swelling, chronic phase can be expressed as spinal atrophy.
Diagnosis
Diagnosis of spinal cord ischemia
According to the symptoms of transient lower limb weakness and associated with spinal cord injury, it is not difficult to diagnose transient spinal cord ischemia. For those who have sudden paraplegia, the medical history should be detailed. If it occurs after abdominal aortic surgery, it is not difficult to diagnose. Blood due to spinal vascular malformation should be diagnosed by methods such as spinal angiography.
Differential diagnosis
1. Intermittent claudication caused by lower extremity atherosclerosis
The disease occurs in the elderly, has a clear history, after walking a short distance, there is more pain in one side of the lower limbs, numbness and weakness, so that you can not walk, you can continue to walk after rest, but there is no symptoms of spinal cord injury at the time of attack .
2. Embolization vasculitis
More common in middle-aged men, there is no obvious peripheral arteriosclerosis, pain in the foot and calf at the onset, accompanied by decreased skin temperature of the foot, disappearance of the dorsal artery of the foot, cyanosis of the toes, no signs of spinal cord damage.
