延髓梗死的临床、影像学特点及预后分析  

The clinical, radiological and prognostic factor analysis of medullary infarction

作　　者：孙阿萍[1] 刘向一[1] 孙庆利[1] 陈璐[1] 刘晓鲁[1] 樊东升[1] 

机构地区：[1]北京大学第三医院神经内科,100191

出　　处：《中华内科杂志》2016年第5期361-365,共5页Chinese Journal of Internal Medicine

摘　　要：目的 探讨延髓梗死（MI）的临床表现和影像学特点,并对比延髓外侧梗死（LMI）和延髓内侧梗死（MMI）的临床特点.方法 对北京大学第三医院神经内科2009年1月至2014年12月收治的62例急性MI患者进行回顾性分析,包括危险因素、临床症状体征、实验室检查、影像学特点、病因及随访情况.结果 62例患者中48例LMI,14例MMI（其中双侧梗死2例）.LMI组和MMI组的发病年龄分别为（60.2±12.3）岁和（56.9±14.2）岁.LMI组病灶多位于延髓中、上段[40例（83.3％）],最常见的症状和体征为眩晕38例（79.2％）、感觉障碍33例（68.8％）、构音障碍32例（66.7％）、吞咽困难30例（62.5％）、咽反射减弱30例（62.5％）、霍纳综合征29例（60.4％）、共济失调26例（54.2％）以及恶心呕吐25例（52.1％）.MMI组病灶多位于延髓上段[13例（92.9％）],最常见的症状和体征为运动障碍12例（85.7％）、感觉障碍11例（78.6％）、眩晕10例（71.4％）和构音障碍10例（71.4％）.LMI组和MMI组梗死由动脉粥样硬化所致者分别为35例（72.9％）和12例（85.7％）.LMI组中5例（10.4％）患者住院期间死亡,MMI组有1例（7.1％）住院期间死亡.62例患者中有16例（25.8％）在发病24 h内行MRI-弥散加权成像检查时并未发现病灶.结论 LMI患者的发病年龄较MMI患者偏大,且LMI病灶多位于延髓中、上段,而MMI则以延髓上段多见.椎动脉粥样硬化是MI的最常见病因.LMI组患者预后较MMI组差.Objective To investigate the clinical and radiological features of medullary infarction （MI）, and to compare the clinical characteristics of lateral medullary infarction （LMI） and medial medullary infarction （MMI）.Methods Patients diagnosed as acute MI who were treated from January 2009 to December 2014 in Department of Neurology, Peking University Third Hospital, were retrospectively enrolled in the study and data were analyzed including risk factors, clinical features, laboratory findings, radiological characteristics, etiology and outcomes.Results A total of 62 cases of MI were enrolled with 48 cases of LMI and 14 cases of MMI , including 2 cases of bilateral MMI.The mean onset age of LMI and MMI was 60.2 ± 12.3 and 56.9 ± 14.2, respectively.The frequently affected location of LMI was the middle and upper part of medulla [40 cases （83.3％）].The common symptoms and signs of LMI were dizzy （38 cases ,79.2％）, sensory disturbance （33 cases ,68.8％）, dysarthria （32 cases ,66.7％）, dysphagia （30 cases ,62.5％）, diminished pharyngeal reflex （30 cases, 62.5％）, Homer＇s sign （29 cases, 60.4％）, ataxia （26 cases, 54.2％） and nausea or vomiting （25 cases, 52.1％）.The frequently affected location of MMI was the upper part of medulla （13 cases, 92.9％）.The common symptoms and signs of MMI were motor dysfunction （12 cases, 85.7％）, sensory disturbances （11 cases, 78.6％）, dizzy （10 cases, 71.4％） and dysarthria （10 cases, 71.4％）.Infarctions caused by atherosclerosis were found in 35 cases of LMI （72.9％） and 12 cases of MMI （85.7％）.Five cases （10.4％） of LMI died in hospital, while 1 case （7.1％） of MMI died in hospital.No lesion was found in 16 cases （25.8％） by MRI-DWI within the first 24 hours of onset.Conclusions Our study showes that the mean onset age of LMI is older than that of MMI.The lesion of LMI is frequently located in the upper and middle medulla, whereas the lesion of MMI is mostly in the upper me

关 键 词：梗死 延髓 延髓外侧梗死 延髓内侧梗死 动脉粥样硬化 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]