颈髓缺血性脑卒中：文献综述与临床病例报告

封面


如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

论证。脊髓缺血性脑卒中是一种罕见病，仅占所有脑卒中病例的约1%。由于该病在儿童中罕见，且与其他急性脊髓病综合征的鉴别诊断较为困难，预后常较差，同时临床医生对该病在儿科中的认知有限，因此本研究具有较高的现实意义。

临床观察。本文报告一例8岁儿童急性脊髓病综合征的临床病例。颈段脊髓磁共振成像结果与临床表现相符，提示在颈部脊髓前脊髓动脉供血区存在循环障碍。

讨论。脊髓急性循环障碍的可能原因包括系统性低血压、供血脊髓的血管闭塞（创伤性、医源性、血栓性或栓塞性）、动脉夹层、动静脉畸形与瘘管，以及高凝状态等。

结论。在儿童出现急性脊髓病综合征时，除了炎症性和感染性病因外，应将“脊髓缺血性脑卒中” 作为重要的鉴别诊断，特别是在具有高危因素的患儿中。早期识别脊髓急性血流障碍对于及时开展神经影像学检查、相关学科会诊至关重要；一旦明确急性缺血的病因，应尽早进行病因治疗或对症治疗，并启动早期康复。

全文:

受限制的访问

作者简介

Alina M. Khodorovskaya

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: alinamyh@gmail.com
ORCID iD: 0000-0002-2772-6747
SPIN 代码: 3348-8038

MD

俄罗斯联邦, Saint Petersburg

Olga E. Agranovich

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: olga_agranovich@yahoo.com
ORCID iD: 0000-0002-6655-4108
SPIN 代码: 4393-3694

MD, PhD, Dr. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Margarita V. Savina

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: drevma@yandex.ru
ORCID iD: 0000-0001-8225-3885
SPIN 代码: 5710-4790
Scopus 作者 ID: 57193277614

MD, PhD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Ekaterina V. Petrova

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: pet_kitten@mail.ru
ORCID iD: 0000-0002-1596-3358
SPIN 代码: 2492-1260
Scopus 作者 ID: 57194563255

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Sergey F. Batkin

H. Turner National Medical Research Center for Children’s Orthopedics and Trauma Surgery

Email: sergey-batkin@mail.ru
ORCID iD: 0000-0001-9992-8906
SPIN 代码: 5173-9340

MD, PhD, Cand. Sci. (Medicine)

俄罗斯联邦, Saint Petersburg

Anna D. Dreval

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: anndreval@yandex.ru
ORCID iD: 0009-0007-3985-634X
SPIN 代码: 4175-6620
俄罗斯联邦, Saint Petersburg

Daniil B. Vcherashniy

Ioffe Physical Technical Institute

编辑信件的主要联系方式.
Email: dan-v@yandex.ru
ORCID iD: 0000-0003-1658-789X
SPIN 代码: 6139-7842

PhD, Cand. Sci. (Physics and Mathematics)

俄罗斯联邦, Saint Petersburg

参考

  1. Romi F, Naess H. Spinal cord infarction in clinical neurology: a review of characteristics and long-term prognosis in comparison to cerebral infarction. Eur Neurol. 2016;76(3–4):95–98. doi: 10.1159/000446700
  2. Pigna F, Lana S, Bellini C, et al Spinal cord infarction. A case report and narrative review. Acta Biomed. 2021;92(S1):2021080. doi: 10.23750/abm.v92iS1.8395
  3. Hsu JL, Cheng MY, Liao MF, et al. The etiologies and prognosis associated with spinal cord infarction. Ann Clin Transl Neurol. 2019;6(8):1456–1464. doi: 10.1002/acn3.50840
  4. Sandson TA, Friedman JH. Spinal cord infarction: report of 8 cases and review of the literature. Medicine. 1989;68(5):282–292. doi: 10.1097/00005792-198909000-00003
  5. Morshid A, Jadiry HA, Chaudhry U, et al. Pediatric spinal cord infarction following a minor trauma: a case report. Spinal Cord Ser Cases. 2020;6(1):95. doi: 10.1038/s41394-020-00344-8 EDN: KSIVIF
  6. Nance JR, Golomb MR. Ischemic spinal cord infarction in children without vertebral fracture. Pediatr Neurol. 2007;36(4):209–216. doi: 10.1016/j.pediatrneurol.2007.01
  7. Pikija S, Kunz AB, Nardone R, et al. Spontaneous spinal cord infarction in Austria: a two-center comparative study. Ther Adv Neurol Disord. 2022;15:17562864221076321. doi: 10.1177/17562864221076321 EDN: NAMEEQ
  8. English SW, Rabinstein AA, Flanagan EP, et al. Spinal cord transient ischemic attack: Insights from a series of spontaneous spinal cord infarction. Neurol Clin Pract. 2020;10(6):480–483. doi: 10.1212/CPJ.0000000000000778 EDN: NFNAAB
  9. Watermeyer F, Stampfli ML, Hahn M, et al. Anterior spinal artery syndrome in a 14-year-old boy. J Child Sci. 2023;13(1):e134–e138. doi: 10.1055/s-0043-1778034 EDN: MZEYQI
  10. Sheikh A, Warren D, Childs AM, et al. Paediatric spinal cord infarction-a review of the literature and two case reports. Childs Nerv Syst. 2017;33(4):671–676. doi: 10.1007/s00381-016-3295-8 EDN: XCOSFW
  11. Transverse Myelitis Consortium Working Group. Proposed diagnostic criteria and nosology of acute transverse myelitis. Neurology. 2002;59(4):499–505. doi: 10.1212/wnl.59.4.499
  12. Moore KL, Dalley AF, Agur AMR. Clinically orientated anatomy. 7th ed. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; 2013. 1168 p.
  13. Santillan A, Nacarino V, Greenberg E, et al. Vascular anatomy of the spinal cord. J Neurointerv Surg. 2012;4(1):67–74. doi: 10.1136/neurintsurg-2011-010018
  14. Skoromets AA, Skoromets TA. Paroxysmal circulatory disorders in the vertebral arteries. Neurological Bulletin. 1993;25(1–2):31–34. doi: 10.17816/nb105920 EDN: IWAROG
  15. Little SB, Sarma A, Bajaj M, et al. Imaging of vertebral artery dissection in children: an underrecognized condition with high risk of recurrent. Stroke. Radiographics. 2023;43(12):e230107. doi: 10.1148/rg.230107 EDN: ROFQGT
  16. Fedaravičius A, Feinstein Y, Lazar I, et al. Successful management of spinal cord ischemia in a pediatric patient with fibrocartilaginous embolism: illustrative case. J Neurosurg. Case Lessons. 2021;2(11):CASE21380. doi: 10.3171/CASE21380 EDN: JBCMGM
  17. Hodorovskaya AM. Spinal dural arteriovenous fistula. Neurosurgery and neurology of children. 2010;(2):61–69. EDN: NSLENZ
  18. Bandyopadhyay S, Sheth RD. Acute spinal cord infarction: vascular steal in arteriovenous malformation. J Child Neurol. 1999;(14):685–687. doi: 10.1177/088307389901401012 EDN: DENOXH
  19. Riche MC, Modenesi-Freitas J, Djindjian M, et al. Arteriovenous malformations (avm) of the spinal cord in children. A review of 38 cases. Neuroradiology. 1982;22:171–180. doi: 10.1007/bf00341245 EDN: FNGZMK
  20. Hakimi K.N., Massagli T.L. Anterior spinal artery syndrome in two children with genetic thrombotic disorders. J Spinal Cord Med. 2005;28(1):69–73. doi: 10.1080/10790268.2005.11753801
  21. Young G, Manco-Johnson M, Gill JC, et al. Clinical manifestations of the prothrombin G20210A mutation in children: a pediatric coagulation consortium study. J Thromb Haemost. 2003;1(5):958–962. doi: 10.1046/j.1538-7836.2003.00116.x EDN: BGTUKX
  22. Hasegawa M, Yamashita J, Yamashima T, et al. Spinal cord infarction associated with primary antiphospholipid syndrome in a young child. Case report. J Neurosurg. 1993;79(3):446–450. doi: 10.3171/jns.1993.79.3.0446
  23. Ciceri EF, Opancina V, Pellegrino C, et al. Fibrocartilaginous embolism: a rare cause leading to spinal cord infarction? Neurol Sci. 2023;44(1):263–271. doi: 10.1007/s10072-022-06398-w EDN: RPEQBF
  24. Ahluwalia R, Hayes L, Chandra T, et al. Pediatric fibrocartilaginous embolism inducing paralysis. Childs Nerv Syst. 2020;36(2):441–446. doi: 10.1007/s00381-019-04381-z EDN: MHGZCS
  25. Naiman JL, Donohue WL, Prichard JS. Fatal nucleus pulposus embolism of spinal cord after trauma. Neurology. 1961;11:83–87. doi: 10.1212/WNL.11.1.83
  26. Yadav N, Pendharkar H, Kulkarni GB. Spinal cord infarction: clinical and radiological features. J Stroke Cerebrovasc Dis. 2018;27(10):2810–2821. doi: 10.1016/j.jstrokecerebrovasdis.2018.06.008
  27. Diehn FE, Maus TP, Morris JM, et al. Uncommon manifestations of intervertebral disk pathologic conditions. Radiographics. 2016;36(3):801–823. doi: 10.1148/rg.2016150223
  28. Cuello JP, Ortega-Gutierrez S, Linares G, et al. Acute cervical myelopathy due to presumed fibrocartilaginous embolism: a case report and systematic review of the literature. J Spinal Disord Tech. 2014;27(8):E276–E281. doi: 10.1097/BSD.0000000000000115
  29. Rengarajan B, Venkateswaran S, McMillan HJ. Acute asymmetrical spinal infarct secondary to fibrocartilaginous embolism. Childs Nerv Syst. 2015;31(3):487–491. doi: 10.1007/s00381-014-2562-9 EDN: KPXOIC
  30. AbdelRazek MA, Mowla A, Farooq S, et al. Fibrocartilaginous embolism: a comprehensive review of an under-studied cause of spinal cord infarction and proposed diagnostic criteria. J Spinal Cord Med. 2016;39(11)146–154. doi: 10.1080/10790268.2015.1116726
  31. Fullerton HJ, Johnston SC, Smith WS. Arterial dissection and stroke in children. Neurology. 2001;57(7):1155–1160. doi: 10.1212/wnl.57.7.1155
  32. Shlobin NA, Azad HA, Mitra A, et al. Characteristics and predictors of outcome of pseudoaneurysms associated with vertebral artery dissections: a 310-patient case series. Oper Neurosurg (Hagerstown). 2021;20(5):456–461. doi: 10.1093/ons/opaa464 EDN: GJUTHA
  33. Arnold M, Kurmann R, Galimanis A, et al. Differences in demographic characteristics and risk factors in patients with spontaneous vertebral artery dissections with and without ischemic events. Stroke. 2010;41(4):802–804. doi: 10.1161/STROKEAHA.109.570655
  34. Nash M, Rafay MF. Craniocervical arterial dissection in children: pathophysiology and management. Pediatr Neurol. 2019;95:9–18. doi: 10.1016/j.pediatrneurol.2019.01.020
  35. Jadeja N, Nalleballe K. Bow hunter syndrome: a rare cause of posterior circulation stroke: do not look the other way. Neurology. 2018;91(7):329–331. doi: 10.1212/WNL.0000000000006009
  36. Ferriero DM, Fullerton HJ, Bernard TJ, et al.; American Heart Association stroke council and council on cardiovascular and stroke nursing. Management of stroke in neonates and children: a scientific statement from the American Heart Association/American Stroke Association. Stroke. 2019;50(3):e51–e96. doi: 10.1161/STR.0000000000000183
  37. Braga BP, Sillero R, Pereira RM, et al. Dynamic compression in vertebral artery dissection in children: apropos of a new protocol. Childs Nerv Syst. 2021;37(4):1285–1293. doi: 10.1007/s00381-020-04956-1 EDN: RQDJRQ
  38. Fox CK, Fullerton HJ, Hetts SW, et al. Single-center series of boys with recurrent strokes and rotational vertebral arteriopathy. Neurology. 2020;95(13):e1830–e1834. doi: 10.1212/WNL.0000000000010416 EDN: HMALKA
  39. Hu Y, Du J, Liu Z, et al. Vertebral artery dissection caused by atlantoaxial dislocation: a case report and review of literature. Childs Nerv Syst. 2019;35(1):187–190. doi: 10.1007/s00381-018-3948-x EDN: JAHXGZ
  40. Simonnet H, Deiva K, Bellesme C, et al. Extracranial vertebral artery dissection in children: natural history and management. Neuroradiology. 2015;57(7):729–738. doi: 10.1007/s00234-015-1520-x EDN: HOQUHB
  41. Montalvo M, Bayer A, Azher I, et al. Spinal cord infarction because of spontaneous vertebral artery dissection. Stroke. 2018;49(11):e314–e317. doi: 10.1161/STROKEAHA.118.022333
  42. Robertson CE, Brown RD, Wijdicks EF, et al. Recovery after spinal cord infarcts: long-term outcome in 115 patients. Neurology. 2012;78:114–121. doi: 10.1212/WNL.0b013e31823efc93
  43. Hannawi Y, Parnes M, Zhorne L, et al. A diagnostic dilemma: cervical cord infarction caused by vertebral artery dissection and mimicking a demyelinating disease. Neurology. 2012;78(Suppl 1):03.136. doi: 10.1212/WNL.78.1_MeetingAbstracts.P03.136
  44. Weidauer S, Nichtweiß M, Hattingen E, et al. Spinal cord ischemia: aetiology, clinical syndromes and imaging features. Neuroradiology. 2015;57(3):241–257. doi: 10.1007/s00234-014-1464-6 EDN: OGHRLN
  45. Ros Castelló V, Sánchez Sánchez A, Natera Villalba E, et al. Spinal cord infarction: Aetiology, imaging findings, and Prognostic factors in a series of 41 patients. Neurologia (Engl Ed). 2021. doi: 10.1016/j.nrl.2020.11.014
  46. Batsou V, Benetos IS, Vlamis I, et al. Spinal cord ischemia: a review of clinical and imaging features, risk factors and long-term prognosis. Acta Orthopaedica et Traumatologica Hellenica. 2023;74(3):54–60.
  47. Vargas MI, Gariani J, Sztajzel R, et al. Spinal cord ischemia: practical imaging tips, pearls, and pitfalls. AJNR Am J Neuroradiol. 2015;36(5):825–830. doi: 10.3174/ajnr.A4118
  48. Masson C, Pruvo JP, Meder JF, et al. Spinal cord infarction: clinical and magnetic resonance imaging findings and short term outcome. J Neurol Neurosurg Psychiatry. 2004;75(10):1431–1435. doi: 10.1136/jnnp.2003.031724
  49. Peckham ME, Hutchins TA. Imaging of vascular disorders of the spine. Radiol Clin North Am. 2019;57(2):307–318. doi: 10.1016/j.rcl.2018.09.005 EDN: YDACZW
  50. Kuker W, Weller M, Klose U, et al. Diffusion-weighted MRI of spinal cord infarction-high resolution imaging and time course of diffusion abnormality. J Neurol. 2004;251:818–824. doi: 10.1007/s00415-004-0434-z EDN: GGVUIZ
  51. Meinicke H, Moske-Eick O, Sitzberger AN, et al. Anterior spinal artery syndrome in a 13-year-old boy 8 days after taekwondo-fight: vascular obliteration due to vessel lesion or thrombophilia? Klin Padiatr. 2011;223(3):182–186. doi: 10.1055/s-0031-1275311
  52. Uohara MY, Beslow LA, Billinghurst L, et al. Incidence of recurrence in posterior circulation childhood arterial ischemic stroke. JAMA Neurol. 2017;74(3):316–323. doi: 10.1001/jamaneurol.2016.5166
  53. Reisner A, Gary MF, Chern JJ, et al. Spinal cord infarction following minor trauma in children: fibrocartilaginous embolism as a putative cause. J Neurosurg Pediatr. 2013;11(4):445–450. doi: 10.3171/2013.1.PEDS12382
  54. Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6(1):I–LXII. doi: 10.1177/2396987321989865 EDN: TZYYSN
  55. Focke JK, Seitz RJ. Reversal of acute spinal cord ischemia by intravenous thrombolysis. Neurol Clin Pract. 2021;11(6):975–976. doi: 10.1212/CPJ.0000000000001097 EDN: MHXFEV
  56. Müller KI, Steffensen LH, Johnsen SH. Thrombolysis in anterior spinal artery syndrome. BMJ Case Rep. 2012;2012:bcr2012006862. doi: 10.1136/bcr-2012-006862
  57. Rigney L, Cappelen-Smith C, Sebire D, et al. Nontraumatic spinal cord ischaemic syndrome. J Clin Neurosci. 2015;22(10):1544–1549. doi: 10.1016/j.jocn.2015.03.037

补充文件

附件文件
动作
1. JATS XML
下载
2. Fig. 1. Magnetic resonance imaging of the cervical spinal cord: a — sagittal projection; b — axial projection. Arrows indicate areas of spinal cord ischemia. Description in text.

下载 (114KB)
索引源数据

版权所有 © Eco-Vector, 2025


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС77-54261 от 24 мая 2013 г.