髓外硬膜下脊髓海绵状血管瘤导致的蛛网膜下腔出血的临床分析(附1例报告)

Clinical analysis of subarachnoid hemorrhage caused by intradural extramedullary spinal cavernous hemangioma (report of one case)

目的 分析髓外硬膜下脊髓海绵状血管瘤(SCH)导致的蛛网膜下腔出血(SAH)的临床特点。方法 对1例以SAH为临床表现的髓外硬膜下SCH患者的临床资料进行回顾性分析,并复习相关文献。结果 本例为中老年男性,以突发头痛起病,脑膜刺激征阳性。头颅CT及DSA检查均未见明显异常,腰穿CSF检查证实为SAH。脊髓MRI成像可见T_(12)水平髓外硬膜下呈短T_(1)及短T_(2)信号的病灶,周围斑片状异常信号影,增强扫描可见结节状强化灶。最终诊断为髓外硬膜下SCH导致的SAH。检索既往报道的髓外硬膜下SCH导致的SAH患者11例,结合本例分析发现,多数患者以SAH起病,少数患者存在慢性SAH的临床表现。病灶位置以腰段多见,胸段次之。12例患者经积极的手术治疗,多数预后良好。结论 髓外硬膜下SCH是SAH的罕见病因。此类患者多数临床表现不典型,且DSA阴性,脊髓MRI特征性的病灶有助于明确诊断。手术治疗对缓解患者的症状、改善预后具有重要意义。

Objective To analyze the clinical characteristics of subarachnoid hemorrhage(SAH) caused by intradural extramedullary spinal cavernous hemangioma(SCH).Methods The clinical data of one case of intradural extramedullary SCH presenting with SAH was retrospectively analyzed,and relevant literatures were reviewed.Results This case was a middle-aged male with a sudden headache and positive meningeal irritation.Brain CT and DSA on admission showed no obvious abnormality.CSF obtained through lumbar puncture confirm the presence of SAH.MRI of the spinal cord showed a low-signal intensity nidus in T_(1)-and T_(2)-weighted images in the intradural-extramedullary area of T_(12)segments.There were abnormal plaque-like signal shadows around the lesions,and nodular enhancement lesions could be seen on contrast-enhanced MRI.The final diagnosis was SAH caused by intradural extramedullary SCH.Eleven previously reported cases of intradural extramedullary SCH complicated with SAH were reviewed.Combined with this case,it was found that most patients had the onset with SAH,and a few patients had the clinical manifestations of chronic SAH.Most of the lesions were located in the lumbar segment,followed by the thoracic segment.A majority of the 12 patients had a good prognosis after timely surgical treatment.Conclusions Intradural extramedullary SCH is a rare etiology of SAH.Most of these patients have atypical clinical manifestations and negative DSA,and the specific lesion of spinal MRI helps to make a definite diagnosis.Surgical treatment is of great significance to relieve the symptoms and improve the prognosis of patients.