急性双侧延髓内侧梗死临床诊治一例并文献复习  

Clinical diagnosis and treatment of acute bilateral medial medullary infarction:a case report and literature review

作　　者：罗兰珠 陈淦 杨水泉 李桂岚 邝秋萍 严梓乐 Luo Lanzhu;Chen Gan;Yang Shuiquan;Li Guilan;Kuang Qiuping;Yan Zile(Department of Neurology,Sanshui People′s Hospital,Foshan,Guangdong 528100,China)

机构地区：[1]广东省佛山市三水区人民医院神经内科,528100 [2]广东省佛山市南海区第六人民医院神经内科,528248

出　　处：《中国脑血管病杂志》2024年第11期778-781,共4页Chinese Journal of Cerebrovascular Diseases

摘　　要：双侧延髓内侧梗死(MMI)是一种较为罕见的卒中亚型,其临床表现较为复杂,导致诊疗过程中易出现误诊。双侧MMI患者病情进展迅速,易进展为呼吸衰竭,甚至死亡。药物治疗对于该类型脑梗死患者的效果欠佳。作者回顾性分析1例双侧MMI患者的病例资料,患者以右侧肢体无力为首发症状,伴言语不清,经头部MR检查最终明确其病因为大动脉粥样硬化型。该患者左侧椎动脉V4段发出的左侧小脑后下动脉后以远闭塞,采用支架取栓及球囊扩张术治疗,出院后3个月电话随访显示患者预后良好。通过复习文献,结合该例患者的临床及影像学特征初步分析认为,大动脉粥样硬化可能是双侧MMI最常见的病因,头部MR检查是诊断该病的重要方法;对于伴有椎动脉V4段闭塞的双侧MMI患者,可尝试行血管内介入治疗。Bilateral medial medullary infarction(MMI)was a rare subtype of stroke.The clinical manifestations of bilateral MMI were complicated,which leaded to misdiagnosis.Patients with bilateral MMI could progress rapidly,and were easy to progress to respiratory failure and even death.Patients with this type of cerebral infarction did not respond well to medication.One case data of a patient with bilateral MMI was reviewed and analyzed.The weakness on the right side of the body was presented,accompanied by slurred speech,and was finally diagnosed with atherosclerosis of the large arteries through cranial MR examination.The patient had occlusion of the left posterior inferior cerebellar artery distal to the left vertebral artery V4 segment on the left side.The patient was treated with stent thrombectomy and balloon angioplasty,and the follow-up phone call at 3 months after discharge was showed good prognosis.Through a review of the literature,combined with the clinical and imaging features of this case,a preliminary analysis suggested that atherosclerosis of the large arteries may be the most common cause of bilateral MMI.Cranial MR imaging is an important method for diagnosing this condition.For patients with bilateral MMI accompanied by occlusion of the vertebral artery V4 segment,endovascular intervention may be attempted.

关 键 词：脑梗死 延髓内侧梗死 诊断 治疗 取栓术 

分 类 号：R743.33[医药卫生—神经病学与精神病学]