目的：探讨脊髓“蛇眼征”的影像学特征、病理基础及诊断思路，提高对相关脊髓病变尤其是急性脊髓缺血的认识。

方法：回顾性分析1例急性起病、颈髓MRI提示“蛇眼征”的女性患者的临床表现、神经系统查体、影像学及实验室检查资料，并结合相关文献分析该征象的影像学特征及鉴别诊断。

结果：患者以突发背痛起病，数小时内进展为四肢无力及尿潴留。颈髓 MRI 示 C5～7 节段髓内异常信号，横断面双侧前角区呈对称性类圆形高信号，表现为“蛇眼征”；脊髓血管造影提示脊髓前动脉显示欠清。脑脊液常规及生化检查未见明显异常，相关免疫学抗体检测均为阴性。结合临床及影像学表现，首先考虑脊髓前动脉综合征。3个月后复查MRI，提示病灶范围缩小。

结论：“蛇眼征”提示脊髓前角选择性受累，但并非脊髓缺血的特异性征象。对于急性起病、快速进展并伴运动、感觉及自主神经功能障碍的患者，应高度警惕脊髓前动脉供血区缺血，同时结合病程、MRI、血管影像、脑脊液及免疫学检查与压迫性、炎性等脊髓病变进行鉴别。

Objective: To characterize the imaging features, pathological basis, and diagnostic approach to the spinal cord “snake-eyes sign”, with particular emphasis on its relevance to acute spinal cord ischemia.

Methods: The clinical presentation, neurological examination, imaging findings, and laboratory data of a woman with acute-onset myelopathy and the “snake-eyes sign” on cervical spinal cord MRI was retrospectively reviewed, and the imaging characteristics and differential diagnosis were discussed in conjunction with the literature.

Results: The patient developed sudden back pain followed within hours by quadriparesis and urinary retention. Cervical spinal cord MRI showed an intramedullary lesion at the C5-7 levels, with bilateral symmetric round hyperintensities in the anterior horns on axial images, consistent with the “snake-eyes sign”. Spinal angiography showed poor visualization of the anterior spinal artery. Cerebrospinal fluid routine and biochemical studies were unremarkable, and relevant immunological antibody tests were negative. Anterior spinal artery syndrome was considered the leading diagnosis. Follow-up MRI at 3 months showed a reduction in lesion extent.

Conclusion: The “snake-eyes sign” indicates selective involvement of the anterior horns but is not specific for spinal cord ischemia. In patients with acute, rapidly progressive motor, sensory, and autonomic dysfunction, anterior spinal artery territory ischemia should be strongly considered, while the clinical course, MRI, vascular imaging, cerebrospinal fluid findings, and immunological studies should be integrated to distinguish ischemic lesions from compressive, inflammatory, and other myelopathies.