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患者,男,68岁。于1991年6月1日晨整理房间卫生时突然腰部疼痛,向腹部窜痛,疼痛剧烈,全身出汗,当时双下肢尚能活动。约半小时后,疼痛自行缓解,双下肢不能活动,小便潴留,大便失禁。既往有冠心病史2年。1987年始不明原因出现间歇性双下肢力弱,步行15至20米时即感双下肢疲劳,休息后好转,未行治疗。入院查体:胸腰椎棘突无叩痛,两侧T_(12)以下痛觉丧失。左侧呈节段性分布,左T_(12)至S_2痛觉丧失,左肛周、阴囊部痛觉存在;右T_(12)至S_2痛觉消失。触觉正常,音叉振动觉双侧额前上棘以下消失,双足趾位置觉,运动觉正常。双下肢弛缓性瘫痪,肌张力消失。腱反射右下肢尚可引出,左下肢消失。肛门反射,球海绵体反射消失,双侧病理反射阳性。双下肢无汗,皮温低。腰椎穿刺,恼脊液压力1.078kPa,压颈试验椎管通畅;脑脊液常规、生化检验正常。椎管造影CT示腰椎椎管狭窄,脑CT示有基底节区梗
Patient, male, 68 years old. In the morning of June 1, 1991 morning when the room cleaning the sudden waist pain, pain in the abdomen, severe pain, sweating, when still able to lower extremity activities. About half an hour later, the pain relief, the lower extremity can not move, urinary retention, fecal incontinence. Past history of coronary heart disease 2 years. The beginning of 1987 unexplained intermittent weakness of both lower extremities, walking 15 to 20 meters when the feeling of both lower extremity fatigue, rest after the turn, did not cure. Admission examination: thoracolumbar spinous process without percussion pain, both sides of T_ (12) the following pain loss. Left segmental distribution, left T_ (12) to S_2 pain loss, left perianal, scrotal pain exist; right T_ (12) to S_2 pain disappeared. Tactile normal, tuning fork vibration bilateral anterior superior spine on both sides following disappear, double-toe position feel, exercise normal. Both lower extremity flaccid paralysis, muscle tension disappeared. Tendon reflex right lower extremity can still lead to the left lower extremity disappeared. Anus reflex, ball sponge reflex disappears, bilateral pathology reflex positive. No lower limbs sweat, skin temperature is low. Lumbar puncture, irritation spinal fluid pressure 1.078kPa, cervical spinal canal patency test; routine cerebrospinal fluid, biochemical tests were normal. Spinal angiography CT showed lumbar spinal stenosis, brain CT showed basal ganglia infarction