自发性脊髓蛛网膜下腔出血一例并文献复习

Spontaneous spinal subarachnoid hemorrhage： a case report and literature review

目的探讨自发性脊髓蛛网膜下腔出血（S-SAH）患者的临床特征，提高对自发性S-SAH的认识。方法分析收治的1例自发性S-SAH患者的临床资料、诊治及转归情况并复习相关文献。结果患者女，75岁，为视神经脊髓炎谱系疾病患者。在住院大剂量甲泼尼龙静脉冲击治疗期间，患者突发剧烈移行性背部疼痛，疼痛由背部逐渐发展到颈部和头部，并出现脑膜刺激征。排除主动脉夹层、急性冠脉综合征、肺栓塞及骨折等疾病后，进一步进行头、脊髓MRI扫描，证实脊髓和后颅窝蛛网膜下腔出血，诊断为自发性S-SAH。结论移行性背痛合并脑膜刺激征是自发性S-SAH特征性临床表现，及时行脊髓MRI检查有助于提高早期诊断率。

ObjectiveTo investigate the clinical, laboratory and MRI imaging features of a spontaneous spinal subarachnoid hemorrhage（S-SAH）so as to improve the recognition of spontaneous（S-SAH）.MethodsThe data of clinical, laboratory, MRI imaging features, treatment and prognosis of the spontaneous（S-SAH）were collected and statistically analyzed.Relevant literatures were then reviewed.ResultsThe patient was a 75-year-old woman with neuromyelitisoptica spectrum disorders.During the course of hospitalization for intravenous infusion of high-dose methylprednisolone, the patient suffered from a sudden and severe migrating back pain that gradually progressed from the back to the neck and head, and signs of meningeal irritation occurred.After the exclusion of aortic dissection, acute coronary syndrome, pulmonary embolism, and fractures, further MRI scans of the head and spinal cord were performed.The MRI confirmed subarachnoid hemorrhage located in spinal cord and posterior cranial foss, and the diagnosis was spontaneous S-SAH.ConclusionsMigrating back pain combined with signs of meningeal irritation is a characteristic clinical manifestation of S-SAH, and a prompt MRI evaluation of spinal cord is helpful to improve the early diagnosis and treatment.