延髓背外侧综合征临床分析  

Clinical analysis of Wallenberg's syndrome

作　　者：胡杰 许瑞卿 吕祥龙 王允琴 高颖[2] HU Jie;XU Rui-qing;LV Xiang-long;WANG Yun-qin;GAO Ying(Department of Encephalopathy,Chuzhou Hospital of Intergrated Chinese and Western Medicine,Anhui University of Chinese Medicine,Chuzhou 239000,Anhui,China;Department of Encephalopathy,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]安徽中医药大学附属滁州中西医结合医院脑病科,239000 [2]北京中医药大学东直门医院脑病科,100700

出　　处：《中国现代神经疾病杂志》2019年第1期41-46,共6页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：国家科技支撑计划项目(项目编号:2014BAI10B05)~~

摘　　要：目的总结延髓背外侧综合征的临床特征。方法回顾分析2015年3月至2017年10月共36例延髓背外侧综合征患者的临床表现、影像学特点、病因和诱发因素、治疗和预后。结果 36例患者临床主要表现为头晕、呕吐23例(63.89%),饮水呛咳、吞咽困难21例(58.33%),构音障碍19例(52.78%),感觉障碍17例(47.22%),眼震15例(41.67%),共济失调11例(30.56%),Horner征阳性8例(22.22%),呃逆7例(19.44%),面神经麻痹6例(16.67%),偏瘫5例(13.89%),意识障碍5例(13.89%),复视2例(5.56%);12例(33.33%)符合典型延髓背外侧综合征;MRI均可见延髓背外侧梗死灶,其中上延髓型为10例(27.78%),中延髓型9例(25%),下延髓型17例(47.22%);CTA可见5例(5/10)椎动脉狭窄,3例(3/10)小脑后下动脉狭窄;椎动脉B超可见11例(11/15)椎动脉细小或狭窄;经颅多普勒超声可见5例(5/9)椎动脉和基底动脉血流速度减慢,峰值后移;数字减影血管造影术可见9例(9/13)椎动脉狭窄,2例(2/13)小脑后下动脉狭窄。6例(16.67%)予静脉溶栓,30例(83.33%)予内科综合治疗;34例(94.44%)明显好转,2例(5.56%)因循环衰竭而死亡。结论延髓背外侧综合征临床表现多样,仅部分患者有典型临床表现,明确诊断需结合影像学检查,临床预后与梗死灶部位、面积和并发症等有关。Objective To summarize the clinical features of Wallenberg syndrome(WS).Methods Clinical manifestations, imaging features, etiology and predisposing factors, treatment andprognosis of 36 WS patients from March 2015 to October 2017 were retrospectively analyzed. Results Clinical manifestations of 36 patients included dizziness and vomiting in 23 cases(63.89%), bucking whendrinking water and dysphagia in 21 cases(58.33%), dysarthria in 19 cases(52.78%), sensory disturbance in17 patients(47.22%), nystagmus in 15 cases(41.67%), ataxia in 11 cases(30.56%), positive Horner signsin 8 cases(22.22%), hiccups in 7 cases(19.44%), facial nerve paralysis in 6 cases(16.67%), hemiplegia in5 cases(13.89%), conscious disturbance in 5 patients(13.89%), and double vision in 2 cases(5.56%).Twelve patients(33.33%) had typical dorsolateral medullary syndrome. MRI revealed medulla oblongatadorsolateral infarcts, which were located in upper medulla oblongata in 10 cases(27.78%), medial medullaoblongata in 9 cases(25%) and lower medulla oblongata in 17 cases(47.22%). CTA of 10 cases showedvertebral artery(VA) stenosis in 5 patients(5/10), and posterior inferior cerebellar artery(PICA) stenosis in3 cases(3/10). VA ultrasound of 15 cases showed narrowing or stenosis in 11 cases(11/15). TranscranialDoppler ultrasonography(TCD) of 9 cases showed slowed blood flow velocity of VA and basilar artery(BA)and peak backwards in 5 cases(5/9). Digital subtraction angiography(DSA) of 13 cases showed VAstenosis in 9 cases(9/13) and PICA stenosis in 2 cases(2/13). Six cases(16.67%) were treated byintravenous thrombolysis, and 30 cases(83.33%) were treated by comprehensive medical treatment. Of all patients, 34 cases(94.44%) were significantly improved, including 18 cases with reduced symptoms, 6 caseswith residual sensory disturbance, 6 cases with residual positive Horner sign, 4 cases with residual ataxia.Two cases(5.56%) died of circulatory failure. Conclusions The clinical manifestations of Wallenbergsyndrome are varied, only some patients have typic

关 键 词：延髓外侧综合征 小脑后下动脉(非MeSH词) 椎动脉 磁共振成像 

分 类 号：R743[医药卫生—神经病学与精神病学]