Data for: Sudden paraparesia in an old man

The first consideration with this presentation pattern is a spinal cord lesion, most likely anterior cord syndrome characterized by loss of motor function, pain, pinprick, and light touch below the level of the lesion .
In general, pathologic processes involving the spinal cord may be divided into processes affecting the cord or its blood supply primarily and processes that compress the cord, most often originating outside the dura.The main causes of anterior cord syndrome are external compression (such as mass, discopathy, trauma) , ischemia (such as aortic surgery or involvement, aortic angiography, laceration or thrombosis of the anterior spinal artery or a major feeding vessel, severe hypotension, myocardial infarction , vasospasm),Inflammation, infection and demyelination. Note that lesions from ischemia usually are incomplete. If the physical examination does not support a cord syndrome or cauda equina syndrome (absence of UMN signs or a clear thoracic pinprick level, loss of perianal sensation and rectal tone, and urinary retention), the patient may have a peripheral neuropathy affecting the longest nerve tracts first (such as Guillain-Barré syndrome).

此呈现模式的首要考虑因素为脊髓损伤，最可能是前脊髓综合征，其特征为损伤水平以下运动功能丧失、疼痛、针刺感和轻触感。总体而言，涉及脊髓的病理过程可分为主要影响脊髓或其血供的过程以及压迫脊髓的过程，后者通常起源于硬脑膜之外。前脊髓综合征的主要病因包括外部压迫（如肿块、椎间盘病变、创伤）、缺血（如主动脉手术或涉及、主动脉造影、前脊髓动脉或主要供血血管的撕裂或血栓形成、严重低血压、心肌梗死、血管痉挛）、炎症、感染和脱髓鞘。请注意，缺血性病变通常是不完全的。如果体格检查不支持脊髓综合征或马尾综合征（缺乏上运动神经元征或明确的胸部针刺感水平、肛门周围感觉和直肠张力丧失，以及尿潴留），患者可能患有影响最长神经束的周围神经病（如吉兰-巴雷综合征）。