Dissecting aneurysm with anterior spinal artery syndrome: a case report 夏嘉川，罗忠纯，叶 茜，郭祥奎，邓 强，董丽佳，程 焱（四川省乐山市人民医院康复医学科 614000）第一作者简介：男（1987-），主治医师，研究方向：骨科学与康复医学电话：（0833）2114748E-mail：376946199@qq.com doi：10.3969/j.issn.1004-406X.2020.07.13 中图分类号：R744.1 文献标识码：B 文章编号：1004-406X（2020）-07-0666-04脊髓前动脉综合征（anterior spinal artery syndrome，ASAS）是一种纵向延伸性脊髓缺血性疾病，在神经系统疾病中较为少见，但发病原因众多，症状复杂，临床误诊、漏诊率较高。现将我科收治的1例ASAS进行报道并结合相关文献，对ASAS的病因、临床特征、影像表现、治疗方案及预后进行讨论，以期提高临床医师对此疾病的认识和诊治水平。
图1 2019年9月15日全主动脉CTA a 夹层动脉瘤，撕裂的内膜向腔内移位，升主动脉及降主动脉均受累 b 夹层破口起自主动脉弓，近端累及右无名动脉、双侧颈动脉、升主动脉、主动脉窦，远端累及左锁骨下动脉、降主动脉、腹主动脉下段 图2 2019年9月30日脊柱MRI矢状位示T1~T5水平脊髓前2/3区域病变 a T1WI呈现等信号及稍低信号影 b T2WI呈现高信号影 图3 2020年3月3日脊柱MRI：矢状位病变脊髓萎缩变细并出现软化灶 a T1WI信号基本正常 b T2WI呈现稍高信号影Figure 1 Total aortic CTA for emergency on September 15, 2019 a Dissecting aneurysm, displacement of intimal flap to the cavity, visible ascending and descending aorta were involved b Crevasses of aortic dissection originated from arcus aortae, with proximal involvement of right innominate artery, bilateral carotid artery, ascending aorta and aortic sinus, distal involvement of the left subclavian artery, descending aorta, and lower segment of abdominal aorta Figure 2 Spinal MRI on September 30, 2019 showed the anterior 2/3 region of the spinal cord lesions at the sagittal level of T1-T5 a T1WI showed equal signal and slightly lower signal shadow b T2WI showed high signal shadow Figure 3 Spinal MRI on March 3, 2020 showed the spinal cord of sagittal lesion is atrophic and thin, with softened focus a T1WI signal was basically normal b T2WI showed slightly higher signal shadow 本文为删节版，原文见《中国脊柱脊髓杂志》2020年7月刊