硬脊膜动静脉瘘五例误诊分析

Spinal dural arteriovenous fistula misdiagnosis analysis of five cases

目的探讨硬脊膜动静脉瘘的临床特点及误诊原因。方法分析5例确诊的硬脊膜动静脉瘘的临床、MRI及DSA表现。结果 5例中仅1例急性起病,表现为一侧肢体无力,误诊为急性脑梗死;余4例均慢性病程,表现为双下肢无力和麻木,部分伴有尿频和便秘。其中2例误诊为腰椎间盘突出,2例误诊为多发性硬化,1例误诊为脊髓炎,并予激素治疗后症状无明显好转,仍进行性加重。结论本病早期临床表现无特异性,容易误诊,脊髓MRI为首选,及时行此检查是避免误诊的关键;选择性的脊髓血管造影是诊断本病的金标准。

Objective To explore the clinical features and misdiagnosis of spinal dural arteriovenous fistulas. Methods A retrospective analysis of 5 cases of spinal dural arteriovenous fistula clinical and radiological manifestation. Results Among 5 cases, only 1 cases of acute onset, showed unilateral limb weakness, misdiagnosed as acute cerebral infarction, the remaining 4 cases were chronic disease, manifested as pair of lower limb weakness and numbness, some accompanied by frequent urination and constipation, 2 cases were misdiagnosed as prolapse of lumbar intervertebral disc, 2 cases were misdiagnoses as multiple sclerosis and myelitis, 1 cases were misdiagnoses as myelitis, and to the hormone treatment after symptoms not obvious change for the better, was progressive. Conclusion This disease early clinical manifestation is nonspecific, is easy to be misdiagnosed, spinal cord MRI examination is the preferred check, in time for this examination is the key for avoiding misdiagnosis;selective spinal angiography is the gold standard for the diagnosis of the disease.