13例硬脊膜动静脉瘘的临床特征与误诊分析

Spinal dural arteriovenous fistula(SDAVF) misdiagnosis analysis of 13 cases

目的分析硬脊膜动静脉瘘(SDAVF)的临床、影像学特点、误诊原因,提高临床医生对SDAVF的认识和诊断水平。方法回顾性分析13例脊髓硬脊膜动静脉瘘患者的临床特点、影像学资料。结果 13例患者中12例男性,平均年龄52.3岁。所有患者症状体征均集中在双下肢、二便和性功能。表现为下肢运动障碍、浅感觉障碍、深感觉异常及大小便功能障碍、性功能障碍。3例患者在腰椎穿刺后症状体征曾有加重。以胸腰段脊髓受累为主,可见到脊髓轻度增粗和髓内异常信号灶,脊髓前后有迂曲状、"虫蚀样"的血管流空影;全部患者均经脊髓血管造影明确诊断。11例接受了介入栓塞或手术治疗,10例在治疗后即刻改善,1例复发。4例在糖皮质激素治疗后症状恶化。结论 SDAVF以中老年男性多见,主要表现为进行性加重的运动和感觉功能减退、大小便功能障碍。脑脊液检查无特异性。本病早期临床表现无特异性,容易误诊。脊髓MRI可对其进行初步诊断,是避免误诊的关键,选择性脊髓血管造影是诊断本病的金标准。及早规范的血管栓塞或手术治疗可能取得较好疗效。

Objective To analyze the clinical characteristics, imaging features and the causes of misdiagnosis in or-der to improve the level of undersdand and diagnosis of Spinal dural arteriovenous fistula （SDAVF）. Methods A retro-spective analysis of 13 cases of spinal dural arteriovenous fistula clinical and radiological manifestation was performed. Results Mean age was 52. 3 years （37 ？68 years） and 12 were men. The symptoms and signs of all patients were concen-trated in the lower limbs, defecation and sexual function. Main performance were movement disorders of lower limbs, superfi-cial sensory disturbances, deep paresthesia, bowel and bladder dysfunction, sexual dysfunction. The symptoms of 3 cases were worse after lumbar puncture. The spinal lesions were located in the segment of thorax and lumbar. Spinal MRI showed the swelling and the abnormal signal in the spinal cord lesion. There were “ moth-eaten” flow void phenomena in the sub-arachnoid space. Spinal angiography was underwent in all the patients to verify the diagnosis. 11 of 13 patients accepted therapy of embolism or surgery, 10 cases improved immediately after treatment, 1 case recurrent. The symptoms of 4 cases were worsen after the hormone treatment. Conclusion This discord is seen in middle-aged men more commonly manifes-ting progressive motor and sensory function loss through bowel and bladder dysfunction. The cerebrospinal fluid examination is not specific. The early clinical manifestation of this disease is not specific. It is easy to be misdiagnosed, a MRI examina-tion is the reliable diagnostic method and the key for avoiding misdiagnosis. Selective spinalangiography is the gold standard for the diagnosis of the disease. The therapy of embolism was relatively effective.