并发神经系统损害的主动脉夹层影像学分析.docVIP

并发神经系统损害的主动脉夹层影像学分析 　　作者：齐连生　　作者单位：河南许昌市中心医院神经内科 许昌 　　【摘要】 目的 分析并发神经系统损害的主动脉夹层的临床和影像学特点。方法 回顾分析12例并发神经系统损害的主动脉夹层的临床资料。 结果 以中老年为主，男女之比为2∶1，10例有高血压史，均为急性起病，均有明显的疼痛，发病时均有明显的血压异常，4例伴恶心、呕吐、大汗。神经系统表现：偏瘫4例，截瘫5例，单侧下肢瘫痪3例，偏身感觉障碍4例，感觉异常平面5例，失语1例，声音嘶哑、吞咽困难1例，大小便障碍2例。结论 彩超、CTA、MRA可显示主动脉真假腔并为诊断提供依据。 　　【关键词】 主动脉夹层,神经系统损害,影像学 　　【Abstract】 Objective To investigate the clinical and imaging features of aortic dissection(AD) with damage in nervous system. Methods Clinical data were retrospectively analyzed in 12 cases of AD with damage in nervous system. Results The major cases were over 40 years old. The ratio of male to female was 2∶1. Ten cases had history of hypertensive disease. All cases were acute onset. During onset, prominent pain and obvious abnormal blood pressure occurred in all cases. Four cases had nausea, emesia and severe sweating. The appearance of nervous system: hemiparalysis in 4 cases, paraplegina in 5 cases, monoplegia in 3 cases, metahypesthesia in 4 cases, paresthesia plane existence in 5 cases, aphasia in 1 case, hoarseness, swallowing difficulty in 1 case and voiding defecation disorders in 2 cases. The breast and abdominal part CTA, MRA and vessels ultrasound of all cases showed the signs of dissected vesselwalls. Conclusion The main clinical manifestations of AD with damage in nervous system are the impaired symptoms and signs of brain and spinal cord, obvious abnormal blood pressure and prominent pain. CTA, MRA and ultrasound examinations can show the true and false lumens and offer evidence for diagnosis. 　　【Key words】 Aortic dissection; Damage in nervous system; Imaging 　　主动脉夹层指主动脉腔内的血流通过内膜裂口进入主动脉壁中层形成夹层血肿并沿主动脉壁延伸剥离而导致血管壁分层病变。起病凶险，临床表现复杂多变，部分并发神经系统损害[1]。总结我院近10年来收治的12例并发明显神经系统损害的主动脉夹层病例的临床及影像学资料，分析如下。 　　1 资料与方法 　　1.1 一般资料 本组男8例，女4例，年龄41～78岁，平均(49±3.4)岁，病程2h～7d;均经影像学证实为主动脉夹层病变。其中有高血压史10例，冠心病史2例;依据Debakeys分型，Ⅰ型4例，Ⅱ型6例，Ⅲ型2例。 　　1.2 临床表现 本组12例均为急性起病。主要症状：剧烈胸痛4例，胸背痛4例，腹痛3例，腰痛1例，恶心、呕吐、大汗淋漓3例。主要体征：血压升高7例，血压降低4例，血压测不到1例。神经系统表现，偏