延髓背外侧综合征36例临床分析  

Clinical analysis of 36 cases of dorsolateral medullary syndrome

作　　者：马敏敏[1] 刘新峰[1] 何晓军[2] 徐格林[1] 朱武生[1] 张仁良[1] 殷勤[1] 

机构地区：[1]南京大学医学院临床医院(南京军区南京总医院)神经内科,210002 [2]解放军第81医院神经内科

出　　处：《临床神经病学杂志》2006年第6期466-467,共2页Journal of Clinical Neurology

基　　金："人类健康;持续进化的探索研究"课题;江苏省"六大人才高峰"第二批资助项目[苏人通(2005)6号]

摘　　要：目的探讨延髓背外侧综合征的临床特点及治疗方法。方法回顾性分析36例延髓背外侧综合征患者的临床资料。结果本组患者以急性或亚急性起病，以眩晕（83．3％）、构音障碍（61．1％）、吞咽困难（52．8％）、Homer征（80．6％）、共济失调（72．2％）及交叉性感觉障碍（50％）为常见临床表现。36例行MRI检查，32例示延髓背外侧梗死；13例行DSA检查，6例示不同程度椎动脉病变，2例示小脑后下动脉闭塞，1例示椎动脉闭塞伴同侧小脑后下动脉狭窄。33例采用抗凝、抗血小板、活血化瘀治疗，26例于7～10d后症状缓解，1～2个月后症状基本消失；6例遗留不同程度的感觉障碍和共济失调；1例死亡。3例行血管内成形及支架植入术，术后当天症状缓解，1周后症状完全消失。结论延髓背外侧综合征是以延髓背外侧局部供血不足而引起的一组综合征，MRI对诊断有较高的敏感性，DSA检查可明确病变部位及程度，血管内介入治疗是延髓背外侧综合征的有效治疗方法。Objective To investigate the clinical characteristics and therapy methods of dorsolateral medullary syndrome. Methods The clinical data of 36 cases of dorsolateral medullary syndrome were analyzed retrospectively. Results The palients presented with acute or sub-acute oneset. Vertigo （83.3%）, dysarthria （61.1%） ,dysphagia （52. 8% ） ,Homer＇s syndrome （80. 6% ） , ataxia （72. 2% ） and crossed sensory disturbance （50%） were the most common symptoms and signs. MRI examination demonstrated dorsolateral medullary infarction in 32 of 36 patients. 13 patients received DSA examination and the results showed 6 patients with different degree disease of vertebral arery, 2 patients with isolated posterior inferior cerebellar artery occlusion, 1 patient with vertebral occlusion and ipsilateral posterior inferior cerebellar artery stenosis. In 33 patients who received anticoagnlation, antiplatelet and activating blood circulation to dissipate blood stasis therapies, 26 patients improved 7～10 days after treatments and the symptoms almost disappeared during 1 - 2 months. 6 cases remained different degree sensory disturbance and ataxia 1 case died. 3 patients were treated with pereutaneous transluminal angioplasty and stenting. The symptoms relieved at the day of operation and recovered completely 1 week after operation. Conclusions Dorsolateral medullary syndrome is a clinical syndrome because of insufficient blood-supply in local blood vessel. MRI is sensitive for the diagnosis of dorsolateral medullary syndrome. The location and degree of the disease can be identified by DSA. Intervention treatment is an effective method in the therapy of dorsolateral medullary syndrome.

关 键 词：延髓背外侧综合征 临床特点 

分 类 号：R743.3[医药卫生—神经病学与精神病学]