第6节 容易误诊或忽视的脊髓血管性疾病举例
自20世纪70年代初期选择性脊髓血管造影的出现，我们对脊髓血管性疾病有了更清楚的认识，包括其血流动力学和血管构筑学，并陆续出现了相应的分类和治疗方法。随着介入神经放射学和显微外科技术的不断发展，目前该病的治疗水平已经有了突破性进展。但由于该类疾病在临床症状上与脊柱脊髓其他疾病有很多相似之处，在影像学上，用常规的磁共振等方法诊断又较困难，有些患者影像学特征不明显，而且椎管狭窄、椎间盘突出等脊柱退行性疾病以及脊髓脱髓鞘病变又是中老年患者非常常见的疾病，导致很多患者既有脊髓血管性疾病，同时又伴有其他疾病，因此更容易引起诊断甚至治疗方面的误诊、误治，举例如下：
病例一：女性，58岁，进行性双上肢麻木、无力1个月，MRI显示颈椎椎管狭窄等退行性病变，同时还可见脊髓髓内水肿（图30-4A、B），DSA证实为颅内硬脑膜动静脉瘘，并向颈髓引流，导致脊髓水肿（图30-4C、D）。
病例二：女性，52岁，腰痛半年，伴随下肢麻木。MRI显示颈椎椎管狭窄等退行性病变，同时还可见脊髓髓内水肿和异常血管影（图30-5A）。DSA证实为颅内硬脑膜动静脉瘘，并向颈髓引流，导致脊髓水肿（图30-5B）。
图30-4 病例一
图30-5 病例二
（黄承光 矫健）
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