脊髄硬膜動静脈瘻の臨床症状と画像所見の特徴 誤診と治療予後
脊髄硬膜動静脈瘻は下肢しびれ・歩行障害・膀胱直腸障害など深刻な神経症状を引き起こす. 正しい診断と治療を受けずに時間が経過すると神経症状が悪化し臨床転帰が悪化する. 東京都立神経病院で治療を行った全50例を後方視的に分析した. 臨床症状は, 胸髄症, 円錐上部症候群, 脊髄円錐症候群の混在した像を呈していたにもかかわらず, 40例 (80%) は初診時に誤診された. 胸椎MRIを受けた症例は正しく診断されたが腰椎MRIを受けた症例は誤診された. 腰部脊柱管狭窄症では説明のつかない症状を認めたときには, 脊髄硬膜動静脈瘻を鑑別診断に挙げ, 確定診断のために胸椎MRIが必要である....
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| Published in | 脳神経外科ジャーナル Vol. 31; no. 5; pp. 295 - 301 |
|---|---|
| Main Author | |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人日本脳神経外科コングレス
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0917-950X 2187-3100 |
| DOI | 10.7887/jcns.31.295 |
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| Abstract | 脊髄硬膜動静脈瘻は下肢しびれ・歩行障害・膀胱直腸障害など深刻な神経症状を引き起こす. 正しい診断と治療を受けずに時間が経過すると神経症状が悪化し臨床転帰が悪化する. 東京都立神経病院で治療を行った全50例を後方視的に分析した. 臨床症状は, 胸髄症, 円錐上部症候群, 脊髄円錐症候群の混在した像を呈していたにもかかわらず, 40例 (80%) は初診時に誤診された. 胸椎MRIを受けた症例は正しく診断されたが腰椎MRIを受けた症例は誤診された. 腰部脊柱管狭窄症では説明のつかない症状を認めたときには, 脊髄硬膜動静脈瘻を鑑別診断に挙げ, 確定診断のために胸椎MRIが必要である. |
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| AbstractList | 脊髄硬膜動静脈瘻は下肢しびれ・歩行障害・膀胱直腸障害など深刻な神経症状を引き起こす. 正しい診断と治療を受けずに時間が経過すると神経症状が悪化し臨床転帰が悪化する. 東京都立神経病院で治療を行った全50例を後方視的に分析した. 臨床症状は, 胸髄症, 円錐上部症候群, 脊髄円錐症候群の混在した像を呈していたにもかかわらず, 40例 (80%) は初診時に誤診された. 胸椎MRIを受けた症例は正しく診断されたが腰椎MRIを受けた症例は誤診された. 腰部脊柱管狭窄症では説明のつかない症状を認めたときには, 脊髄硬膜動静脈瘻を鑑別診断に挙げ, 確定診断のために胸椎MRIが必要である. |
| Author | 髙井, 敬介 |
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| References | 9) Takai K : Spinal arteriovenous shunts : angioarchitecture and historical changes in classification. Neurol Med Chir (Tokyo) 57 : 356-365, 2017. 12) Takai K, Taniguchi M : Clinical and neuroimaging findings of spinal dural arteriovenous fistulas : How to avoid misdiagnosis of this disease. J Orthop Sci 24 : 1027-1032, 2019. 11) Takai K, Komori T, Taniguchi M : Microvascular anatomy of spinal dural arteriovenous fistulas : arteriovenous connections and their relationships with the dura mater. J Neurosurg Spine 23 : 526-533, 2015. 8) Murai S, Hiramatsu M, Suzuki E, Ishibashi R, Takai H, Miyazaki Y, Takasugi Y, Yamaoka Y, Nishi K, Takahashi Y, Haruma J, Hishikawa T, Yasuhara T, Chin M, Matsubara S, Uno M, Tokunaga K, Sugiu K, Date I ; Okayama Cranial and Spinal A-V Shunts (OCSS) Study Group : Trends in incidence of intracranial and spinal arteriovenous shunts : hospital-based surveillance in Okayama, Japan. Stroke 52 : 1455-1459, 2021. 7) McKeon A, Lindell EP, Atkinson JLD, Weinshenker BG, Piepgras DG, Pittock SJ : Pearls & oy-sters : clues for spinal dural arteriovenous fistulae. Neurology 76 : e10-12, 2011. 2) Brinjikji W, Nasr DM, Morris JM, Rabinstein AA, Lanzino G : Clinical outcomes of patients with delayed diagnosis of spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 37 : 380-386, 2016. 1) Aminoff MJ, Logue V : The prognosis of patients with spinal vascular malformations. Brain 97 : 211-218, 1974. 4) Iovtchev I, Hiller N, Ofran Y, Schwartz I, Cohen J, Rubin SA, Meiner Z : Late diagnosis of spinal dural arteriovenous fistulas resulting in severe lower-extremity weakness : a case series. Spine J 15 : e39-44, 2015. 13) Toossi S, Josephson SA, Hetts SW, Chin CT, Kralik S, Jun P, Douglas VC : Utility of MRI in spinal arteriovenous fistula. Neurology 79 : 25-30, 2012. 6) Jellema K, Tijssen CC, van Gijn J : Spinal dural arteriovenous fistulas : a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain 129 : 3150-3164, 2006. 3) Hurst RW, Grossman RI : Peripheral spinal cord hypointensity on T2-weighted MR images : a reliable imaging sign of venous hypertensive myelopathy. AJNR Am J Neuroradiol 21 : 781-786, 2000. 5) Jellema K, Canta LR, Tijssen CC, van Rooij WJ, Koudstaal PJ, van Gijn J : Spinal dural arteriovenous fistulas : clinical features in 80 patients. J Neurol Neurosurg Psychiatry 74 : 1438-1440, 2003. 10) Takai K, Endo T, Yasuhara T, Seki T, Watanabe K, Tanaka Y, Kurokawa R, Kanaya H, Honda F, Itabashi T, Ishikawa O, Murata H, Tanaka T, Nishimura Y, Eguchi K, Takami T, Watanabe Y, Nishida T, Hiramatsu M, Ohtonari T, Yamaguchi S, Mitsuhara T, Matsui S, Uchikado H, Hattori G, Yamahata H, Taniguchi M : Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas : a multicenter study of 195 patients. J Neurosurg Spine 34 : 514-521, 2021. |
| References_xml | – reference: 4) Iovtchev I, Hiller N, Ofran Y, Schwartz I, Cohen J, Rubin SA, Meiner Z : Late diagnosis of spinal dural arteriovenous fistulas resulting in severe lower-extremity weakness : a case series. Spine J 15 : e39-44, 2015. – reference: 5) Jellema K, Canta LR, Tijssen CC, van Rooij WJ, Koudstaal PJ, van Gijn J : Spinal dural arteriovenous fistulas : clinical features in 80 patients. J Neurol Neurosurg Psychiatry 74 : 1438-1440, 2003. – reference: 2) Brinjikji W, Nasr DM, Morris JM, Rabinstein AA, Lanzino G : Clinical outcomes of patients with delayed diagnosis of spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol 37 : 380-386, 2016. – reference: 8) Murai S, Hiramatsu M, Suzuki E, Ishibashi R, Takai H, Miyazaki Y, Takasugi Y, Yamaoka Y, Nishi K, Takahashi Y, Haruma J, Hishikawa T, Yasuhara T, Chin M, Matsubara S, Uno M, Tokunaga K, Sugiu K, Date I ; Okayama Cranial and Spinal A-V Shunts (OCSS) Study Group : Trends in incidence of intracranial and spinal arteriovenous shunts : hospital-based surveillance in Okayama, Japan. Stroke 52 : 1455-1459, 2021. – reference: 12) Takai K, Taniguchi M : Clinical and neuroimaging findings of spinal dural arteriovenous fistulas : How to avoid misdiagnosis of this disease. J Orthop Sci 24 : 1027-1032, 2019. – reference: 7) McKeon A, Lindell EP, Atkinson JLD, Weinshenker BG, Piepgras DG, Pittock SJ : Pearls & oy-sters : clues for spinal dural arteriovenous fistulae. Neurology 76 : e10-12, 2011. – reference: 1) Aminoff MJ, Logue V : The prognosis of patients with spinal vascular malformations. Brain 97 : 211-218, 1974. – reference: 9) Takai K : Spinal arteriovenous shunts : angioarchitecture and historical changes in classification. Neurol Med Chir (Tokyo) 57 : 356-365, 2017. – reference: 11) Takai K, Komori T, Taniguchi M : Microvascular anatomy of spinal dural arteriovenous fistulas : arteriovenous connections and their relationships with the dura mater. J Neurosurg Spine 23 : 526-533, 2015. – reference: 10) Takai K, Endo T, Yasuhara T, Seki T, Watanabe K, Tanaka Y, Kurokawa R, Kanaya H, Honda F, Itabashi T, Ishikawa O, Murata H, Tanaka T, Nishimura Y, Eguchi K, Takami T, Watanabe Y, Nishida T, Hiramatsu M, Ohtonari T, Yamaguchi S, Mitsuhara T, Matsui S, Uchikado H, Hattori G, Yamahata H, Taniguchi M : Neurosurgical versus endovascular treatment of spinal dural arteriovenous fistulas : a multicenter study of 195 patients. J Neurosurg Spine 34 : 514-521, 2021. – reference: 3) Hurst RW, Grossman RI : Peripheral spinal cord hypointensity on T2-weighted MR images : a reliable imaging sign of venous hypertensive myelopathy. AJNR Am J Neuroradiol 21 : 781-786, 2000. – reference: 13) Toossi S, Josephson SA, Hetts SW, Chin CT, Kralik S, Jun P, Douglas VC : Utility of MRI in spinal arteriovenous fistula. Neurology 79 : 25-30, 2012. – reference: 6) Jellema K, Tijssen CC, van Gijn J : Spinal dural arteriovenous fistulas : a congestive myelopathy that initially mimics a peripheral nerve disorder. Brain 129 : 3150-3164, 2006. |
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| Snippet | 脊髄硬膜動静脈瘻は下肢しびれ・歩行障害・膀胱直腸障害など深刻な神経症状を引き起こす. 正しい診断と治療を受けずに時間が経過すると神経症状が悪化し臨床転帰が悪... |
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| SubjectTerms | clinical presentation misdiagnosis neuroimaging findings outcome spinal dural arteriovenous fistula |
| Subtitle | 誤診と治療予後 |
| Title | 脊髄硬膜動静脈瘻の臨床症状と画像所見の特徴 |
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