10例自发性脊髓出血临床特征及预后的影响因素OACSTPCD

Objective To analyze the clinical symptoms,imaging and related hematological examination results,diagnosis and treatment of patients with spontaneous spinal cord hemorrhage,and to inuestigate the main factors affecting the prognosis.Methods The clinical data of 10 patients with spontaneous spinal cord hemorrhage from 2015 to 2023 were analyzed retrospectively.JOA score and ASIA injury grade were used to evaluate myelopathy and mRS scale to evaluate the prognosis of patients with spontaneous spinal cord hemorrhage.Results Nerve root pain occurred in 9 cases,and motor,sensory and autonomic nerve involvement were found in 10 cases.The etiology of 5 patients was considered to be spinal vascular malformation,and the other 5 cases was unknown.Three patients underwent decompression surgery.One patient was ASIA grade A before operation,and the last follow-up was still grade A,while the other two patients'ASIA grade recovered from preoperative grade B and C to grade D.Seven patients were treated conservatively in internal medicine,of which 3 cases were admitted to ASIA grade A,1 case recovered to grade D,the other 2 cases were still grade A,the other 4 cases were admitted to ASIA grade B-D,2 cases recovered to grade E and 2 cases recovered to grade D at the last follow-up.The recovery rate of patients with mild,moderate and severe disability according to JOA score was 72.2%,52.8%,2.9%,respectively.Conclusion Spinal vascular malformation is the most common cause of spinal cord hemorrhage.CT negative can not rule out spinal cord hemorrhage.MRI is of high diagnostic value for spinal cord hemorrhage.Surgical treatment is the first choice for patients with adaptation,and the prognosis of patients with severe neurological dysfunction is poor by operation or conservative treatment.JOA score and mRS score in the early stage of spinal cord hemorrhage have guiding significance for the evaluation of prognosis.