单侧延髓背外侧综合征及并发呼吸衰竭临床特征分析  

Clinical features of unilateral Wallenberg syndrome and respiratory failure

作　　者：高琳芝 张爱娟[2] 张爱元[3] 马梦冰 钟孟飞[1] GAO Lin-zhi;ZHANG Ai-juan;ZHANG Ai-yuan;MA Meng-bing;ZHONG Meng-fei(Department of Neurology,Shengli Oilfield Central Hospital,Dongying 257034,Shandong,China;Department of Neurology,Weifang People's Hospital,Weifang 261000,Shandong,China;Department of Cardiology,Weifang People's Hospital,Weifang 261000,Shandong,China)

机构地区：[1]胜利油田中心医院神经内科,东营257034 [2]山东省潍坊市人民医院神经内科,261000 [3]山东省潍坊市人民医院心内科,261000

出　　处：《中国现代神经疾病杂志》2023年第12期1129-1133,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

摘　　要：目的总结单侧延髓背外侧综合征的临床特征。方法与结果回顾分析2005年3月至2021年11月山东省东营市胜利油田中心医院和潍坊市人民医院诊断与治疗的28例单侧延髓背外侧综合征患者临床资料。临床主要表现为痛温觉减退占92.86%(26/28),共济失调占85.71%(24/28),肢体麻木占75%(21/28),头晕占71.43%(20/28);MRI均可见延髓背外侧梗死灶,病变位于延髓头部9例(32.14%)、中部7例(25%)、尾部12例(42.86%);CTA显示27例(96.43%)存在责任动脉,分别为椎动脉狭窄(15例,53.57%)、小脑后下动脉闭塞(10例,35.71%)、双侧椎动脉闭塞和单侧椎动脉夹层(各1例,3.57%)。11例(39.29%)予以静脉溶栓,其中3例桥接椎动脉支架植入术,17例(60.71%)予以保守治疗;19例(67.86%)预后良好,9例(32.14%)预后不良。5例(17.86%)并发呼吸衰竭,对症治疗后1例预后良好、1例呼吸机辅助通气、1例重残、2例死亡。结论单侧延髓背外侧综合征临床表现多样,影像学检查对明确诊断具有重要意义,部分患者可并发呼吸衰竭,应密切监测其呼吸功能。Objective To summarize the clinical features of unilateral Wallenberg syndrome.Methods and Results The clinical data of 28 patients with unilateral Wallenberg syndrome admitted to Shengli Oilfield Central Hospital and Weifang People′s Hospital from March 2005 to November 2021 were retrospectively analyzed.Clinical manifestations were pain and temperature disturbance in 26 cases(92.86%),ataxia in 24 cases(85.71%),numbness in 21 cases(75%),dizziness in 20 cases(71.43%);MRI showed dorsolateral medulla oblongata infarction lesion in all patients,9 cases(32.14%)with lesions located in the rostral medulla oblongata,7 cases(25%)in the central region and 12 cases(42.86%)in the caudal region;CTA showed there were responsible arteries in 27 cases(96.43%),including vertebral artery stenosis(15 cases,53.57%),posterior inferior cerebellar artery occlusion(10 cases,35.71%),bilateral vertebral artery occlusion and unilateral vertebral artery dissection(one case each,3.57%).Eleven cases(39.29%)were treated with intravenous thrombolysis,including 3 cases with bridging vertebral artery stent implantation and 17 cases(60.71%)with conservative treatment.19 cases(67.86%)had a good prognosis,while 9 cases(32.14%)had a poor prognosis.There are 5 cases(17.86%)complicated with respiratory failure,one case with good prognosis after symptomatic treatment,one case of ventilator assisted ventilation,one case was severely disabled,and 2 cases were dead.Conclusions Unilateral Wallenberg syndrome has multiple clinical manifestations,imaging examination has great significance for clear diagnosis,some patients may develop respiratory failure and their respiratory function should be closely monitored.

关 键 词：延髓外侧综合征 呼吸功能不全 椎动脉 磁共振成像 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R563.8[医药卫生—临床医学]