老年患者类似椎管狭窄的神经障碍。一系列临床观察

E. G. Seliverstova, A. Y. Kordonskiy, E. S. Druzhinina, E. K. Romanenko, A. A. Grin
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摘要

椎管狭窄症是由于年龄相关变化引起的椎管中央、侧袋或椎间孔的病理性狭窄,包括椎间盘病理、小关节、韧带肥大、骨赘形成和弓破坏。在临床上,这种疾病可以表现为疼痛,以及麻木或手臂或腿部无力。由于神经影像学资料显示的狭窄程度与临床表现的严重程度之间缺乏相关性,导致了鉴别诊断的复杂性。21%的椎管狭窄患者可能无症状病程。椎管狭窄症必须与下肢血管动脉粥样硬化、类风湿性关节炎、梨状体综合征、骶髂炎、脊柱炎/椎间盘炎、肌萎缩性侧索硬化症、格林-巴罗综合征等多神经病变相鉴别。孤立性虚弱在临床表现中应引起特别关注。肌肉萎缩,肌腱反射快,锥体征象,肌肉束状,以及患者的主诉同时无力在上肢和下肢伴随。我们提出并讨论三个临床病例的患者推定诊断为椎管狭窄。其中两人接受了手术治疗,但没有达到预期的效果。随后,发现两例患者的进行性四肢肌肉无力的原因是肌萎缩性侧索硬化症,第三例患者患有格林-巴罗综合征,这是一种急性脱髓鞘性多神经病变。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Neurological disorders imitating spinal stenosis in elderly patients. Series of clinical observations
Spinal stenosis is a pathological narrowing of the central spinal canal, lateral pocket, or intervertebral foramen due to age‑related changes, including pathology of the discs, facet joints, ligament hypertrophy, osteophyte formation and destruction of the arches. Clinically, the disease can manifest itself with pain, as well as numbness, or weakness in the arms or legs. The complexity of differential diagnosis is due to the lack of correlation between the degree of stenosis according to neuroimaging data and the severity of clinical manifestations. Spinal stenosis among 21 % of people may have an asymptomatic course. Spinal stenosis has to be differentiated from atherosclerosis of the vessels of the lower extremities, rheumatoid arthritis, piriformis syndrome, sacroiliitis, spondylitis/spondylodiscitis, amyotrophic lateral sclerosis, Guillain–Barré syndrome and other polyneuropathies. Isolated weakness should be of a particular concern in the clinical picture. Muscle hypotrophy, brisk tendon reflexes, the presence of pyramidal signs, muscle fasciculations, as well as patients’ complaints of simultaneous weakness in both the upper and lower extremities accompany them. We present and discuss three clinical cases of patients with a presumptive diagnosis of spinal stenosis. Two of them were held surgical treatment, which did not produce the expected result. Subsequently, it was found that the cause of progressive muscle weakness in the limbs was amyotrophic lateral sclerosis in two patients and the third one had Guillain–Barré syndrome, a form of acute demyelinating polyneuropathy.
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