15例延髓梗死的临床表现及影像学特征分析  

Clinical and imaging features of 15 patients with medullary infarction

作　　者：杨新光[1] 卢洋鹏 高聪[1] 解龙昌[1] 蒲蜀湘[1] 龙友明[1] 何毅华[1] 殷建瑞[1] 

机构地区：[1]广州医科大学附属第二医院神经内科,广州510260

出　　处：《中华神经医学杂志》2016年第8期830-834,共5页Chinese Journal of Neuromedicine

基　　金：广东省科技计划项目（20128031800231）

摘　　要：目的探讨延髓梗死的临床表现及影像学特征，为延髓梗死的早期诊断和治疗提供思路。方法收集广州医科大学附属第二医院神经内科自2015年1月至12月收治的15例延髓梗死患者的临床资料，所有患者均行头颅MRI检查明确为延髓梗死[按梗死部位分为延髓内侧梗死（包括双侧延髓内侧梗死）组、延髓外侧梗死组]，分析其临床表现及影像学特征。结果2组患者最常见的临床表现及阳性体征为肢体肌力减退、构音障碍或声音嘶哑、共济失调及感觉障碍。仅1例延髓外侧梗死患者表现为典型的延髓背外侧综合征，其余6例均为部分或不典型表现。8例延髓内侧梗死患者中只有2例表现为较典型的延髓旁正中综合征，1例表现为不典型的杰克逊综合征，其余5例仅表现为部分肢体肌力减退，伴或不伴感觉障碍。15例患者MRI DWI序列检查均提示为高信号，其中7例延髓外侧梗死患者均为延髓背外侧梗死（左侧2例，右侧5例），8例延髓内侧梗死患者均为延髓腹中侧梗死（左侧4例，右侧2例，双侧2例）；2例双侧延髓内侧梗死患者的DWI序列发现特征性的＂Y＂形表现及＂心＂形表现。结论延髓梗死的临床表现复杂且缺乏特异性；延髓内外侧梗死由于病损的部位及范围、侧支循环的代偿能力等不同，临床症状有着明显差异；对于不典型的病例，早期头颅MRI DWI检查对明确诊断和决定治疗方案有着重要意义。Objective To investigate the clinical and imaging features of medullary infarction and provide new thoughts for early diagnosis and treatment of medullary infarction. Methods Fifteen patients with medullary infarction, admitted to our hospital from January 2015 to December 2015, were chosen in our study. All patients were performed MR imaging to confirm medullary infarction; and according to the infarction sites, they were divided into medial medullary infarction group and lateral medullary infarction group. Their clinical features and imaging characteristics were analyzed and compared. Results The most common manifestation and positive body sign in the two groups included decreased limb muscular strength, dysarthrosis/hoarseness, ataxia and sensory disturbance; in the lateral medullary infarction group, only one patient had typical Wallenberg syndrome and the other 6 did not have typical features; in the 8 patients from medullary infarction group, only two had typical Dejerine syndrome, one had Jackson＇s syndrome, and the other 5 only manifested as partial decreased limb muscular strength. MR diffusion weighted imaging indicated left lateral medullary infarction in two and right lateral medullary infarction in 5 of the medullary infarction group, and left medullary infarction in 4, right medullary infarction in two and bilateral medullary infarction in two of the medullary infarction group. Two patients with bilateral medullary infarction had typical ＂Y＂ or ＂Love＂ shape in MR diffusion weighted imaging. Conclusions Medullary infarction, especially bilateral medial infarction, is a rare type of stroke without specific clinical features; the positions, spectrums and compensatory ability of collateral circulation are different in the medial and lateral medullary infarctions, therefore, the clinical symptoms are different without specific disciplines. Initial brain MR imaging contributes to earlydiagnosis as well as therapy.

关 键 词：延髓梗死 临床表现 影像学特征 

分 类 号：R743.3[医药卫生—神经病学与精神病学]