以颅内蛛网膜下腔出血为表现的脊髓硬脊膜动静脉瘘4例分析

Analysis of 4 cases of spinal dural arteriovenous fistula presented with intracranial subarachnoid hemorrhage

目的分析以颅内蛛网膜下腔出血(SAH)为首发表现的脊髓硬脊膜动静脉瘘(SDAVF)患者的临床和影像学特点。方法回顾性分析2011年8月—2016年10月首都医科大学附属北京地坛医院神经内科确诊4例颅内SAH患者的临床及影像学资料。结果 4例患者男3例,女1例,年龄48~58岁,均以头痛为主诉,发病时伴腰背部疼痛1例。3例患者头颅CT显示出血位于三、四脑室及桥前池,头颅CT未见异常1例。瘘口位于颈髓患者3例,瘘口位于胸腰髓患者1例。全脑数字减影血管造影(DSA)显示供血动脉为左椎动脉3例,脊髓DSA显示供血动脉为腰动脉1例。4例磁共振成像(MR)示髓周血管流空信号或髓内异常信号。手术患者2例,随访后无复发,余2例拒绝手术,失访。结论以颅内SAH为表现的SDAVF患者,临床症状轻,瘘口多位于颈髓,位于胸腰段者罕见。出血与合并引流静脉迂曲扩张有关,易误诊。临床上需仔细询问病史及查体,避免误诊漏诊。

Objective To investigate the clinical and iconography characteristics of the.spinal dural arteriovenous fistula（SDAVF） which presented with intracranial subaraehnoid hemorrhage （SAH）. Methods The clinical characteristics and iconography results of 4 cases of SAH from August 2011 to October 2016 in Beijing Ditan Hospital, Capital Medical University were retrospectively analyzed. Results Four cases were all presented with headache, 1 case had lower back pain. 3 cases＇ cranial CT showed hemorrhage in third ventricle, fourth ventricle and prepontine cistern, cranial CT of 1 case was normal. The fistulae of 3 cases located in the cervical cord, and 1 case located in the thoracic and lumbar cord. The digital subtraction angiography （DSA） of 3 cases showed that the feeding artery was the left vertebral artery; the last one was lumbar artery. Magnetic resonance imaging （MRI） showed medullary blood vessel flow signals or intra-medullary abnormal signals. Conclusion The fistulae of the SDAVF cases which presented with SAH mostly located in the cervical spinal cord, and with tortuous expansion drainage veins, with mild clinical symptom. It was easy to misdiagnosis. We should be careful to inquiry history and avoid misdiagnosis.