延髓comma状梗死:9例病例系列研究  

Medullary comma-shaped infarctions: nine cases series studies

作　　者：乔晓红 董春玉 丛艳彬[1] 郑福浩 Qiao Xiaohong;Dong Chunyu;Cong Yanbin;Zheng Fuhao(Department of Neurology,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China;Department of Neurointervention,Weihai Central Hospital Affiliated to Qingdao University,Weihai 264400,China)

机构地区：[1]青岛大学附属威海市中心医院神经内科,威海264400 [2]青岛大学附属威海市中心医院神经介入内科,威海264400

出　　处：《国际脑血管病杂志》2024年第3期167-171,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨延髓comma状(即英文逗号状)梗死的临床特点、影像学特征、病因和潜在机制。方法回顾性收集青岛大学附属威海市中心医院2020年1月至2023年9月诊治的延髓comma状梗死患者,对其临床表现、影像学检查结果、治疗和转归情况进行分析和总结。结果共纳入9例延髓comma状梗死患者,其中男性3例,年龄(67.22±14.66)岁(范围39~83岁)。主要临床症状和体征包括病变对侧肢体痛温觉减退(66.67%,6/9)、饮水呛咳/吞咽困难(66.67%,6/9)、病灶侧咽腭肌麻痹(66.67%,6/9)和眩晕(66.67%,6/9)。7例(77.78%,7/9)存在病灶同侧椎动脉重度狭窄或闭塞,1例(11.11%,1/9)存在左侧大脑中动脉闭塞,1例(11.11%,1/9)未见大血管狭窄。发病后90 d时随访显示,改良Rankin量表评分均<2分。结论延髓comma状梗死临床少见,其主要表现为病灶对侧偏身痛温觉减退、饮水呛咳/吞咽困难、病灶侧咽腭肌麻痹、眩晕等,发病机制主要为椎动脉狭窄导致的低灌注。Objective To investigate clinical features,imaging characteristics,etiology,and potential mechanisms of medullary"comma-shaped"infarctions.Methods Patients with common-shaped infarction treated at Weihai Central Hospital Affiliated to Qingdao University from January 2020 to September 2023 were retrospectively collected,and their clinical manifestations,imaging findings,treatment,and outcome were analyzed and summarized.Results A total of 9 patients with medullary common-shaped infarction were enrolled,including 3 males,aged 67.22±14.66 years(ranging from 39 to 83 years).Main clinical symptoms and signs included the decreased pain and temperature sensation on the contralateral limb(66.67%,6/9),coughing or choking while drinking liquids/dysphagia(66.67%,6/9),ipsilateral pharyngopalatine muscle paralysis(66.67%,6/9),and dizziness(66.67%,6/9).Seven patients(77.78%,7/9)had severe stenosis or occlusion at the ipsilateral vertebral artery,one(11.11%,1/9)had occlusion at the left middle cerebral artery,and one(11.11%,1/9)did not have large vessel stenosis.At 90 days after onset,the follow-up showed that the modified Rankin Scale scores were all<2.Conclusions Medullary comma-shaped infarctions are rare in clinical practice,its main manifestations include the decreased pain and temperature sensation on the contralateral limb,coughing or choking while drinking liquids/dysphagia,ipsilateral pharyngopalatine muscle paralysis,dizziness,etc.The pathogenesis is mainly hypoperfusion caused by vertebral artery stenosis.

关 键 词：脑干梗死 延髓 磁共振成像 椎动脉 

分 类 号：R743.33[医药卫生—神经病学与精神病学]