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Rehabilitation Practice and Science

Translated Title

頸椎前脊椎動脈症候群：病例報告

Abstract

A 30 year-old male was sent to the emergency department due to chest pain and radiation to left shoulder. Heart disease was suspected but the electrocardiography and cardiac enzyme examination were negative. Tetraplegia with the dissociated sensory loss occurred later. Pain and temperature sensation decreased, but vibration sensation and proprioception were preserved. Urine retention was also noted, but the bladder sensation seemed to be preserved. The anterior spinal artery syndrome at the lower cervical cord level was diagnosed by the clinical presentation and MRI findings. The negative findings of laboratory examination helped exclude other possible causes. The rehabilitation program was then arranged. Two months later, he could walk independently. The persistent weakness of two hands was probably due to the involvement of anterior horn cells at the lower cervical level. Besides, the self-catherization program had been performed for the voiding dysfunction and the goal of balanced bladder was achieved.The anterior spinal artery syndrome is referred to the infarction of the anterior two-thirds of the spinal cord, which is the territory supplied by the anterior spinal artery. The characteristic clinical presentation of the anterior spinal artery syndrome is the sudden onset of weakness of the involved limbs, the bowel and bladder dysfunction, and the dissociated sensory loss. Perception of pain and temperature is impaired, but the vibration sensation and proprioception are preserved. The etiologies of the anterior spinal artery syndrome are variable. Diagnosis of the anterior spinal artery syndrome depends on its clinical features and exclusion of the other possible causes. The role of the laboratory examination is to exclude the other etiologies. Signal abnormality of the MRI in the anterior spinal artery syndrome seems non-specific for differentiating the etiologies but it can help define the site of involvement. It is supportive for the treatment of the anterior spinal artery syndrome. Management of the voiding dysfunction of these patients is easier than that after traumatic spinal cord injury probably due to the preservation of bladder sensation, which is mediated through the dorsal column. Recovery of the anterior spinal artery syndrome is extremely variable, and the patients with sparing of motor function or pain sensation have the potential to recover and function independently.

Language

Traditional Chinese

First Page

159

Last Page

166

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