頸椎前脊椎動脈症候群：病例報告

Cervical Anterior Spinal Artery Syndrome：A Case Report

陳建鵬(Jiann-Perng Chen) ； 楊百嘉(Baii-Jia Yang)

《中華民國復健醫學會雜誌》 29卷3期 (2001/09) Pp. 159-166

https://doi.org/10.6315/JRMA.200109.0159

摘要

本研究報告一位30歲的男性，由於胸痛並放射至左側肩膀被送至急診，不久即發生四肢癱瘓，並出現分離式感覺缺失現象─疼痛和溫度知覺變差，而振動感覺和本體感覺卻未受影響，此外排尿功能也受影響，由於這種獨特的臨床症狀表現，加上各種檢查排除其他可能病因，我們診斷為前脊椎動脈症候群，並藉由核磁共振檢查進一步確定梗塞的大小、位置，治療方面主要是以支持性療法為主，安排復健治療兩個月後，下肢肌力恢復可獨立行走的程度，但兩手仍然是無力。另外，排尿功能異常經施以自我導尿訓練後，可自行排尿，達到平衡性膀胱的目標。
前脊椎動脈症候群與一般外傷性脊髓損傷的臨床表現不同之處，在於獨特的分離式感覺缺失現象；對於保有部分運動與感覺功能的患者，大部分可恢復不錯的功能；排尿功能也因膀胱感覺較不受影響而較容易訓練。

關鍵字

前脊椎動脈症候群 ； 神經性膀胱病變

並列摘要

A 30 year-old male was sent to the emergency department due to chest pain and radiation to left shoulder. Heart disease was suspected but the electrocardiography and cardiac enzyme examination were negative. Tetraplegia with the dissociated sensory loss occurred later. Pain and temperature sensation decreased, but vibration sensation and proprioception were preserved. Urine retention was also noted, but the bladder sensation seemed to be preserved. The anterior spinal artery syndrome at the lower cervical cord level was diagnosed by the clinical presentation and MRI findings. The negative findings of laboratory examination helped exclude other possible causes. The rehabilitation program was then arranged. Two months later, he could walk independently. The persistent weakness of two hands was probably due to the involvement of anterior horn cells at the lower cervical level. Besides, the self-catherization program had been performed for the voiding dysfunction and the goal of balanced bladder was achieved.
The anterior spinal artery syndrome is referred to the infarction of the anterior two-thirds of the spinal cord, which is the territory supplied by the anterior spinal artery. The characteristic clinical presentation of the anterior spinal artery syndrome is the sudden onset of weakness of the involved limbs, the bowel and bladder dysfunction, and the dissociated sensory loss. Perception of pain and temperature is impaired, but the vibration sensation and proprioception are preserved. The etiologies of the anterior spinal artery syndrome are variable. Diagnosis of the anterior spinal artery syndrome depends on its clinical features and exclusion of the other possible causes. The role of the laboratory examination is to exclude the other etiologies. Signal abnormality of the MRI in the anterior spinal artery syndrome seems non-specific for differentiating the etiologies but it can help define the site of involvement.
It is supportive for the treatment of the anterior spinal artery syndrome. Management of the voiding dysfunction of these patients is easier than that after traumatic spinal cord injury probably due to the preservation of bladder sensation, which is mediated through the dorsal column. Recovery of the anterior spinal artery syndrome is extremely variable, and the patients with sparing of motor function or pain sensation have the potential to recover and function independently.

並列關鍵字

anterior spinal artery syndrome ； neurogenic bladder