A 63-year-old man with a history of hypertension, paroxysmal atrial fibrillation, and dyslipidemia had a sudden intense chest pain radiating to his left arm, and he lost control of his legs. He was not on anticoagulant therapy and had no history of back trauma. During transport, he was hypotensive (blood pressure 88/51), his right arm was pale, and he was not able to move his legs. ECG showed inferolateral ST-segment depressions. He was given 250 mg aspirin and morphine for pain. With intravenous fluid-replacement therapy, his blood pressure rose and the activity of his legs improved. Aortic dissection was suspected, and the patient was urgently admitted to the surgical emergency room within the university hospital. In the emergency room, his blood pressure was 108/62. Cardiac and pulmonary auscultation and abdominal palpation were normal, and peripheral pulses were symmetrical. Computed tomography of the aorta revealed a hematoma next to the ascending aorta, raising a suspicion of type A aortic dissection reaching from the ascending aorta to the beginning of the left renal artery. The aortic valve was intact.
一位63岁男性患者，既往有高血压病、阵发性房颤、高脂血症史，突然出现剧烈胸痛并放射至左侧上肢，伴双下肢无力。未曾接受抗凝治疗，否认背部外伤史。往医院转送过程中，患者出现低血压（血压88/51mmHg），右侧上肢苍白，双下肢不能平移。心电图显示下侧壁ST段压低，给予口服阿司匹林肠溶片250mg和吗啡止痛。给予静脉补液后，患者血压逐渐上升，双下肢运动障碍改善。怀疑主动脉夹层，患者被紧急送往大学医院的外科急诊室。在急诊室，患者血压108/62mmHg。心肺听诊及腹部触诊正常，外周动脉搏动对称。主动脉CT显示升主动脉旁有一血肿，高度怀疑从升主动脉到左侧肾动脉起始段的A型主动脉夹层，主动脉瓣完整。
During an emergency operation, the ascending aorta and a part of the aortic arch were replaced with a prosthetic graft. The arrest time was 24 minutes, and closure of the aorta took 112 minutes. In the beginning, the patient needed vasoactive support because of hypotension but later on his hemodynamic was stable. However, the next day, the patient had to undergo a resternotomy because of postoperative bleeding. After the operation, he was hypertensive and was treated with antihypertensive medication.
急诊手术中，升主动脉和部分主动脉弓用人工移植物代替。停搏时间为24分钟，主动脉夹闭时间为112分钟。因为血压过低，患者一开始需要血管活性药物维持血压，但后来血流动力学平稳。然而第2天，患者因为术后出血，不得不行开胸手术治疗。术后血压高，给予降压药物治疗。
The patient was extubated on the second postoperative day and mobilization was started the next day, when it was noticed that the patient could not stand on his feet and coordination of his lower limbs was impaired. On the fourth postoperative day, a neurologist was consulted. The patient was somnolent but oriented, and denied any back or limb pain. His cranial nerves were intact, and his upper limbs had normal strength and sensation. He could hold his left leg up for 5 and his right leg for 3 s in a prone position. He could not press/push against resistance neither distally nor proximally, the right leg being somewhat weaker, and tonus of his lower limbs was weak-ened. The patient reported impaired sensation for pain and light touch on his feet. Reflexes were normal, and Babinski sign was negative. There was no impaired sensation in upper body. Diuresis was monitored by means of urinary catheter.
术后第2天拔除气管插管，第3天患者下床活动时发现双下肢站立不能，伴共济失调。术后第4天请神经科医生会诊。患者呈嗜睡状态，但定向力正常，否认背部或者四肢痛。颅神经检查正常，双上肢运动及感觉未见异常。患者仰卧位时，左下肢抬起能坚持5秒，右下肢3秒，肢体近端及远端均不能抵抗阻力，右侧下肢比左侧肌力更差，肌张力低。双下肢痛觉和轻触觉减退，腱反射正常存在，巴宾斯基征阴性。上半身感觉正常。通过留置导尿管监测到多尿。
Next, Magnetic Resonance Imaging of the Spinal Cord Was Performed. What Would You Expect to Find?
下一步行脊髓MRI检查，你希望能发现什么呢？
Magnetic resonance imaging showed increased signal intensity of the anterior spinal cord between T11 and conus in T2-weighted images with edema and restricted diffusion in diffusion-weighted images. The finding suggested an ischemic lesion.
磁共振显示胸11至脊髓圆锥段脊髓前部T2加权像高信号，伴有水肿，弥散加权像受限，结果提示脊髓缺血性病变。
On the 19th postoperative day, sensory deficits were no longer found. The patient was able to walk with assistance of a walker, but distal and motor weakness was still detected, the right side being weaker. Proprioceptive and temperature sense was normal. Vibration sense was impaired in both upper and lower limbs, probably unrelated to the acute situation. Bowel function was normal but the patient was still catheter-bound, partially because of the postoperative complication (bleeding in the groin area).
手术后19天，双下肢感觉恢复正常。在他人搀扶下可行走，但双下肢远端肌力仍差，右下肢较明显。本体感觉和温度觉正常。四肢振动觉均受损，可能与此次发病无关。排便功能正常，但患者一直留置导尿，部分原因为术后并发症（出血在腹股沟区）
A few days later, the patient was transferred to the intensive care unit because of septic shock, esophageal perforation, and gastrointestinal bleeding. Despite recurrent surgical interventions, antibiotics, maximal vasoactive medication, massive blood transfusions, and renal replacement therapy, the patient died on the 27th day after admission.
几天后，患者因为感染性休克、食道穿孔、消化道出血被转至重症监护病房。虽然给予多次手术治疗、抗生素、最大量的血管活性药物、大量输血和肾脏替代治疗，但患者在入院后第27天死亡。
Our patient had a motor paraparesis with mild sensory findings and possible paresis of the urinary bladder, suggesting of anterior spinal cord infarction but preserved dorsal column function. We concluded that aortic dissection had caused the infarction, the probable mechanism being occlusion of the anterior segmental medullary artery supplying lower thoracic and upper lumbar level. The fact that the patient had reported paraparesis preoperatively suggested that the causative factor was the dissection and not the operation. An alternative mechanism is hypoperfusion of the spinal cord because of the documented hypotension. The transient alleviation of symptoms after intravenous fluid therapy suggests that hypotension was at least a contributory factor.
患者有截瘫伴轻度感觉障碍，可能有膀胱括约肌功能障碍，提示脊髓前部发生梗死，后索功能保留。我们推测是主动脉夹层导致了脊髓梗死，其发病机制是供应胸下段至腰上段水平的脊前动脉部分闭塞。患者术前出现过双下肢瘫痪，提示脊髓梗死的诱发因素为动脉夹层而非手术。由于患者有低血压史，所以另外一种发生脊髓梗死的机制可能是低灌注。特别是给予静脉输液后症状有短暂性改善，提示低血压至少是促发因素。
Infarction of the spinal cord is a rare cause of paraparesis. It is commonly caused by atheromas involving the aorta and is a potential complication of thoracoabdominal surgery. Other causes include collagen-vascular disease, syphilitic angiitis, embolic infarction, pregnancy, sickle cell disease, neurotoxic effects of iodinated contrast agents, compression of the spinal arteries by tumor, systemic arterial hypotension, and decompression sickness.1
脊髓梗死导致截瘫极为罕见。脊髓梗死的常见病因为主动脉粥样硬化，同时也是胸腹部手术的一种潜在并发症，其他的病因包括：胶原血管病、梅毒性血管炎、血栓栓塞、妊娠、镰状细胞病、碘对比剂的神经毒性作用、肿瘤压迫脊髓动脉、全身性低血压和减压病。
Arteries supplying the spinal cord are branches of the vertebral, thyrocervical, costocervical, intercostal, lumbar, and lateral sacral arteries. Two anterior thirds of the spinal cord are supplied by the anterior spinal artery and the posterior third by 2 posterior arteries, running along the entire length of the cord. They are joined by 6 to 9 large segmental medullary arteries originating from the same arteries except for lateral sacral arteries. In the cervical region, the blood supply is rich in collateral branches. In the thoracic region, the anterior spinal artery is joined by only a few branches from the thoracic aorta, making it more vulnerable to ischemia. Lower thoracic and lumbosacral areas are supplied by the largest medullary artery, the great anterior segmental medullary artery of Adamkiewicz, usually found at level L-1 or L-2 (occasionally as high as T-12 or as low as L-4). Conus and cauda equina are also supplied by the sacral branches ascending from the iliac arteries.
脊髓动脉供应主要来自椎动脉、甲颈干动脉、肋颈干动脉、肋间动脉、腰动脉和骶外侧动脉的分支。脊髓前2/3血液供应主要来自脊髓前动脉，后1/3的血液供应由二条贯穿脊髓全长的后动脉供应，除了骶外侧动脉，起自上述这些动脉的6到9支大的节段性髓动脉也参与供血。颈段脊髓侧支血供非常丰富，在胸段，脊髓前动脉仅接收胸主动脉发出的几根分支的血供，从而使其容易发现缺血，下胸段和腰骶段脊髓由最大的髓动脉供血，较大的前根动脉Adamkiewicz动脉（AKA）,常位于腰1或者腰2水平（偶尔高至胸12或者低至腰4）。脊髓圆锥和马尾有来自髂动脉的骶分支供应。
Aortic dissection begins with an intimal tear whereby blood enters the vessel wall and splays apart the laminar planes of the media to form a false lumen. The dissecting hematoma spreads along the laminar planes and may lead to occlusion of its branches. It may also rupture through the adventitia and cause massive hemorrhage, leading to hypotensive shock. The most common place for spontaneous dissections is the proximal ascending aorta that is susceptible to the greatest sheer stress. Aortic dissections are classified into 2 types. Type A involves the ascending aorta, whereas type B arises after the origin of the great vessels of the aortic arch. The most important risk factor for aortic dissection is hypertension.2
主动脉夹层起源于血管内膜撕裂，血液流入血管壁中，使动脉中层被剥离分开从而形成假腔。夹层中的血肿可能沿着层状平面扩散，导致分支动脉闭塞。也可以是动脉血管外膜破裂，导致大出血，出现低血压性休克。自发性动脉夹层最常见的位置是升主动脉的近端，因为此处血管易受到较大的血流剪应力。主动脉夹层分2型，A型为升主动脉受累，B型为主动脉弓大血管受累。主动脉夹层最主要的危险因素为高血压。
The typical manifestation of aortic dissection is acute intense chest pain that may radiate to back and propagate downward. If it affects the ascending aorta, it may cause cardiac complications such as myocardial infarction, aortic valve insufficiency, or cardiac tamponade. By occluding the arteries originating from the aorta or under general hypotension, dissection can cause hypoperfusion and ischemia of brain, kidneys, limbs, bowel, or spinal cord.
主动脉夹层典型的临床表现为急性剧烈胸痛，放射至背部并向下扩散。如果累及升主动脉，可能会引起心脏并发症，如心肌梗死、主动脉瓣关闭不全或心包填塞。通过堵塞主动脉分支动脉或引起全身性低血压，主动脉夹层可导致脑、肾脏、四肢、肠道或者脊髓血流灌注不足和缺血。
Neurological symptoms of aortic dissection include persistent or transient ischemic stroke, hypoxic encephalopathy, spinal cord ischemia, and ischemic neuropathy.3 Neurological involvement is reported in 17% to 40%.4 Proposed risk factors for neurological complications in type A aortic dissections include advanced age and classic type of dissection.5 At the onset, patients with neurological symptoms are more often pain free than those without (33% versus 5.6%).6 Neurological symptoms often manifest early after dissection and may rapidly resolve. It is speculated that this might be explained by transient arterial occlusion during the propagation of dissection.4 In some studies, neurological complications predicted poor outcome whereas others could not find a correlation.5,6
主动脉夹层的神经系统症状包括持续性或短暂性缺血性卒中、缺氧性脑病、脊髓缺血和缺血性神经病。神经系统受累约占17%—40%。A型主动脉夹层引起神经系统并发症的高危因素包括：高龄和夹层的典型分型。发病时，有神经系统症状的患者无痛的比例高于无神经系统症状的（33% 对 5.6%）。主动脉夹层后神经系统症状通常出现早，且很快缓解，推测这可能是由于主动脉夹层撕裂过程出现短暂性血管闭塞有关，有些研究认为出现神经系统并发症提示愈后不良，而其他研究未发现有相关性。
Spinal cord ischemia is reported in 1% to 9% of type A aortic dissections.4 However, it is more common in distal dissections, ranging ≤10%.7 Spinal cord ischemia in patients with aortic dissection can be caused by occlusion of the intercostal and lumbar arteries, the Adamkiewicz artery, or the thoracic radicular arteries or by hypotension. The most frequent location of infarction is the watershed zone in the middle thoracic spinal cord.1,7
1%—9%A型主动脉夹层出现脊髓缺血，然而，动脉远端夹层中更常见，小于或者等于10%。主动脉夹层患者脊髓缺血的原因可能是肋间动脉、腰动脉、腰膨大动脉或者胸神经根动脉的闭塞，或者低血压。胸中段脊髓的分水岭区为梗死好发部位。
The classic clinical presentation of spinal infarction is the anterior spinal artery syndrome: sudden (primarily plegic) paraplegia, local and radicular pain, sphincter symptoms, loss of pain, and temperature sensation but preserved proprioception and vibration because of sparing of the dorsal columns.1 Importantly, partial syndromes are also seen because of vascular border zones created by anastomosis from penetrating branches of the spinal arteries. If ischemia affects only the motor horns of the spinal cord, pure motor clinical manifestations can be seen.1 It can also manifest as a transverse spinal cord infarction, Brown–Séguard syndrome, progressive myelopathy or transient spinal cord ischemia.4
脊髓梗死的典型临床表现为脊髓前动脉综合征:突然截瘫（主要是瘫痪）、局灶性神经根性疼痛、括约肌功能障碍、痛温觉缺失，但本体感觉和振动觉保留，因为脊髓后索未累及。重要的是，由于脊髓动脉穿通支的吻合形成血管的分水岭区，可表现为脊前动脉部分综合征。如缺血仅影响到运动前角，临床表现就会出现纯运动障碍。也可以表现为横断性脊髓梗死、脊髓半切综合征、进行性脊髓病或一过性脊髓缺血。
Surgical treatment is always indicated in type A aortic dissections, whereas uncomplicated type B dissections can be treated conservatively. Medical treatment aims at managing blood pressure to prevent propagation of dissection without compromising adequate perfusion to vital organs. Two approaches are used in surgical treatment: open surgery, and, more recently, endovascular stent graft repair (TEVAR), which is mainly used in type B dissections. In open surgery, the dissected segment of the aorta is replaced with a prosthetic vascular interposition graft during cross-clamping of the aorta, usually during temporary circulatory arrest in type A. In TEVAR, an endovascular stent graft is placed in the true lumen through the femoral artery while avoiding cross-clamping of the aorta. Both techniques require temporary or permanent interruption of arterial collaterals supplying the spinal cord.
A型主动脉夹层通常选择手术治疗，而不复杂的B型主动脉夹层可以保守治疗。内科治疗的目的是控制血压，防止动脉夹层撕裂延长，导致重要脏器功能障碍。外科手术治疗有2种方法，一种是开胸手术，另一种是最近主要应用于B型主动脉夹层的血管内介入支架修复(TEVAR)。在A型开胸手术中，暂时性循环停止，在主动脉横向钳闭时主动脉撕裂部分血管用人工血管移植物代替。在血管内支架修复术中，血管内支架移植物穿过股动脉被植入真腔，而不需要横向夹闭主动脉。这两种技术均需要暂时或永久性阻断供应脊髓的侧支血管。
The reported frequency of spinal cord ischemia after thoracoabdominal surgery varies widely between 2.6% and 28% in open surgery and between 4% and 7% in endovascular procedures.8,9 Risk factors for postoperative spinal cord ischemia in thoracoabdominal surgery include aneurysm extent, open surgical repair, previous distal aortic operations, cross-clamp duration, the sacrifice of T9–L1 intercostal vessels, emergency operation, severe peripheral vascular disease, perioperative hypotension, and anemia.9,10 Different strategies for spinal cord protection and early detection of ischemia have been used. These include minimizing the surgical time, using hypothermia and pharmacological neuroprotection, protecting spinal cord perfusion by maintaining adequate mean arterial pressure, CSF drainage and by reimplantation of intercostal and lumbar segmental arteries, and using intraoperative monitoring of somatosensory and motor evoked potentials.10
据报道在胸腹部手术后出现脊髓缺血的概率范围很大，在2.6%—28%之间，而血管内介入手术出现的概率在4%-7%。胸腹部手术术后导致脊髓缺血的危险因素包括：动脉瘤的大小、打开手术修复、既往远端主动脉手术史、阻断时间、受累的T9–L1肋间血管、急诊手术、严重的周围血管疾病、围手术期低血压、贫血。各种不同的脊髓保护和早期发现缺血的方法已经被使用，其中包括缩短手术时间，采用低温和神经保护药物、维持足够的平均动脉压以保证脊髓灌注、脑脊液引流和肋间和腰椎节段动脉再植术、术中监测体感和运动诱发电位。
TAKE-HOME POINTS
Aortic dissection can be the cause of neurological dysfunction and should be considered in patients with chest pain, shock, asymmetrical pulses, or new heart murmur.
In case of a sudden nontraumatic motor paraparesis, aortic dissection should be ruled out even in absence of chest pain.
Paraparesis should be recognized as a possible complication of aortic surgery.
Spinal infarction can be diagnosed with magnetic resonance imaging that should include diffusion-weighted images.
总 结
主动脉夹层可能是神经功能障碍的病因，当患者出现胸痛、休克、脉搏不对称、或新的心脏杂音时要想到此病。
当患者出现突发性非创伤性截瘫，即使没有胸痛，也需要排除主动脉夹层。
截瘫应当被认为是主动脉手术的一种并发症。
磁共振包括弥散加权像（DWI）可诊断脊髓梗死。
译文全文
一位63岁男性患者，既往有高血压病、阵发性房颤、高脂血症史，突然出现剧烈胸痛并放射至左侧上肢，伴双下肢无力。未曾接受抗凝治疗，否认背部外伤史。往医院转送过程中，患者出现低血压（血压88/51mmHg），右侧上肢苍白，双下肢不能平移。心电图显示下侧壁ST段压低，给予口服阿司匹林肠溶片250mg和吗啡止痛。给予静脉补液后，患者血压逐渐上升，双下肢运动障碍改善。怀疑主动脉夹层，患者被紧急送往大学医院的外科急诊室。在急诊室，患者血压108/62mmHg。心肺听诊及腹部触诊正常，外周动脉搏动对称。主动脉CT显示升主动脉旁有一血肿，高度怀疑从升主动脉到左侧肾动脉起始段的A型主动脉夹层，主动脉瓣完整。
急诊手术中，升主动脉和部分主动脉弓用人工移植物代替。停搏时间为24分钟，主动脉夹闭时间为112分钟。因为血压过低，患者一开始需要血管活性药物维持血压，但后来血流动力学平稳。然而第2天，患者因为术后出血，不得不行开胸手术治疗。术后血压高，给予降压药物治疗。
术后第2天拔除气管插管，第3天患者下床活动时发现双下肢站立不能，伴共济失调。术后第4天请神经科医生会诊。患者呈嗜睡状态，但定向力正常，否认背部或者四肢痛。颅神经检查正常，双上肢运动及感觉未见异常。患者仰卧位时，左下肢抬起能坚持5秒，右下肢3秒，肢体近端及远端均不能抵抗阻力，右侧下肢比左侧肌力更差，肌张力低。双下肢痛觉和轻触觉减退，腱反射正常存在，巴宾斯基征阴性。上半身感觉正常。通过留置导尿管监测到多尿。
下一步行脊髓MRI检查，你希望能发现什么呢？
磁共振显示胸11至脊髓圆锥段脊髓前部T2加权像高信号，伴有水肿，弥散加权像受限，结果提示脊髓缺血性病变。
手术后19天，双下肢感觉恢复正常。在他人搀扶下可行走，但双下肢远端肌力仍差，右下肢较明显。本体感觉和温度觉正常。四肢振动觉均受损，可能与此次发病无关。排便功能正常，但患者一直留置导尿，部分原因为术后并发症（出血在腹股沟区）
几天后，患者因为感染性休克、食道穿孔、消化道出血被转至重症监护病房。虽然给予多次手术治疗、抗生素、最大量的血管活性药物、大量输血和肾脏替代治疗，但患者在入院后第27天死亡。
患者有截瘫伴轻度感觉障碍，可能有膀胱括约肌功能障碍，提示脊髓前部发生梗死，后索功能保留。我们推测是主动脉夹层导致了脊髓梗死，其发病机制是供应胸下段至腰上段水平的脊前动脉部分闭塞。患者术前出现过双下肢瘫痪，提示脊髓梗死的诱发因素为动脉夹层而非手术。由于患者有低血压史，所以另外一种发生脊髓梗死的机制可能是低灌注。特别是给予静脉输液后症状有短暂性改善，提示低血压至少是促发因素。
脊髓梗死导致截瘫极为罕见。脊髓梗死的常见病因为主动脉粥样硬化，同时也是胸腹部手术的一种潜在并发症，其他的病因包括：胶原血管病、梅毒性血管炎、血栓栓塞、妊娠、镰状细胞病、碘对比剂的神经毒性作用、肿瘤压迫脊髓动脉、全身性低血压和减压病。
脊髓动脉供应主要来自椎动脉、甲颈干动脉、肋颈干动脉、肋间动脉、腰动脉和骶外侧动脉的分支。脊髓前2/3血液供应主要来自脊髓前动脉，后1/3的血液供应由二条贯穿脊髓全长的后动脉供应，除了骶外侧动脉，起自上述这些动脉的6到9支大的节段性髓动脉也参与供血。颈段脊髓侧支血供非常丰富，在胸段，脊髓前动脉仅接收胸主动脉发出的几根分支的血供，从而使其容易发现缺血，下胸段和腰骶段脊髓由最大的髓动脉供血，较大的前根动脉Adamkiewicz动脉（AKA）,常位于腰1或者腰2水平（偶尔高至胸12或者低至腰4）。脊髓圆锥和马尾有来自髂动脉的骶分支供应。
主动脉夹层起源于血管内膜撕裂，血液流入血管壁中，使动脉中层被剥离分开从而形成假腔。夹层中的血肿可能沿着层状平面扩散，导致分支动脉闭塞。也可以是动脉血管外膜破裂，导致大出血，出现低血压性休克。自发性动脉夹层最常见的位置是升主动脉的近端，因为此处血管易受到较大的血流剪应力。主动脉夹层分2型，A型为升主动脉受累，B型为主动脉弓大血管受累。主动脉夹层最主要的危险因素为高血压。
主动脉夹层典型的临床表现为急性剧烈胸痛，放射至背部并向下扩散。如果累及升主动脉，可能会引起心脏并发症，如心肌梗死、主动脉瓣关闭不全或心包填塞。通过堵塞主动脉分支动脉或引起全身性低血压，主动脉夹层可导致脑、肾脏、四肢、肠道或者脊髓血流灌注不足和缺血。
主动脉夹层的神经系统症状包括持续性或短暂性缺血性卒中、缺氧性脑病、脊髓缺血和缺血性神经病。神经系统受累约占17%—40%。A型主动脉夹层引起神经系统并发症的高危因素包括：高龄和夹层的典型分型。发病时，有神经系统症状的患者无痛的比例高于无神经系统症状的（33% 对 5.6%）。主动脉夹层后神经系统症状通常出现早，且很快缓解，推测这可能是由于主动脉夹层撕裂过程出现短暂性血管闭塞有关，有些研究认为出现神经系统并发症提示愈后不良，而其他研究未发现有相关性。
1%—9%A型主动脉夹层出现脊髓缺血，然而，动脉远端夹层中更常见，小于或者等于10%。主动脉夹层患者脊髓缺血的原因可能是肋间动脉、腰动脉、腰膨大动脉或者胸神经根动脉的闭塞，或者低血压。胸中段脊髓的分水岭区为梗死好发部位。
脊髓梗死的典型临床表现为脊髓前动脉综合征:突然截瘫（主要是瘫痪）、局灶性神经根性疼痛、括约肌功能障碍、痛温觉缺失，但本体感觉和振动觉保留，因为脊髓后索未累及。重要的是，由于脊髓动脉穿通支的吻合形成血管的分水岭区，可表现为脊前动脉部分综合征。如缺血仅影响到运动前角，临床表现就会出现纯运动障碍。也可以表现为横断性脊髓梗死、脊髓半切综合征、进行性脊髓病或一过性脊髓缺血。
A型主动脉夹层通常选择手术治疗，而不复杂的B型主动脉夹层可以保守治疗。内科治疗的目的是控制血压，防止动脉夹层撕裂延长，导致重要脏器功能障碍。外科手术治疗有2种方法，一种是开胸手术，另一种是最近主要应用于B型主动脉夹层的血管内介入支架修复(TEVAR)。在A型开胸手术中，暂时性循环停止，在主动脉横向钳闭时主动脉撕裂部分血管用人工血管移植物代替。在血管内支架修复术中，血管内支架移植物穿过股动脉被植入真腔，而不需要横向夹闭主动脉。这两种技术均需要暂时或永久性阻断供应脊髓的侧支血管。
据报道在胸腹部手术后出现脊髓缺血的概率范围很大，在2.6%—28%之间，而血管内介入手术出现的概率在4%-7%。胸腹部手术术后导致脊髓缺血的危险因素包括：动脉瘤的大小、打开手术修复、既往远端主动脉手术史、阻断时间、受累的T9–L1肋间血管、急诊手术、严重的周围血管疾病、围手术期低血压、贫血。各种不同的脊髓保护和早期发现缺血的方法已经被使用，其中包括缩短手术时间，采用低温和神经保护药物、维持足够的平均动脉压以保证脊髓灌注、脑脊液引流和肋间和腰椎节段动脉再植术、术中监测体感和运动诱发电位。
总 结
主动脉夹层可能是神经功能障碍的病因，当患者出现胸痛、休克、脉搏不对称、或新的心脏杂音时要想到此病。
当患者出现突发性非创伤性截瘫，即使没有胸痛，也需要排除主动脉夹层。
截瘫应当被认为是主动脉手术的一种并发症。
磁共振包括弥散加权像（DWI）可诊断脊髓梗死。
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