脊髓亚急性联合变性的临床特征与电生理检查

THE CLINICAL CHARACTERISTIC AND ELECTROPHYSIOLOGIC STUDY OF SUBACUTE COMBINED DEGENERATION OF THE SPINAL CORD

目的:评价脊髓亚急性联合变性(SCD)的临床特征与电生理检查的诊断价值。方法:回顾分析了16例SCD患者的临床特点以及电生理检查等资料。结果:16例SCD患者全部由维生素B12缺乏引起,慢性胃炎及胃大部切除术是其主要病因。肢体感觉异常、深感觉减退、感觉性共济失调及痉挛性截瘫是其主要症状和体征。11例患者合并周围神经损害,1例脑白质受损。9例肌电图检查显示周围神经损害、8例SEP呈中枢传导受损,电生理检查均有阳性发现。7/12血清维生素B12浓度测定低于正常。结论:血清维生素B12浓度正常并不能完全排除SCD;电生理检查高度敏感,对SCD的早期诊断意义重大。

Objective: To evaluate the clinical characteristic and the diagnostic value of electrophysi-ologic study in the subacute combined degeneration of the spinal cord. Methods: The clinical datas, electro-physiocogic study and MRI of 16 cases with SCD were reviewed and analyzed. Results: All of the patients were caused by vitamin B12 deficiency. Chronic gastritis and gastrectomy were main causes. Paresthesia of the limbs, diminished vibration and position sensation, sensory ataxia and spastic paraplegia were the most commonest symptoms and signs. 11 cases were accompanied by peripheral nerve lesion, 1 case by white matter of brain lesion. Electromyogram of the 9 cases shows peripheral nerve lesion. SEP of 8 cases shows the damage of central conduction. Positive findings of electrophysiology were in all of the cases. In 7/12 patients, concentration of serum vitamin B12 was low. Conclusion: The diagnosis of SCD could not be eliminated when the concentration of serum vitamin B12 were normal. Electrophysiologic study had extremely high sensibitity, it could play an important role in the earlier diagnosis of SCD.