31例延髓梗死患者的临床分析

目的:根据头颅MRI对延髓梗死病灶的定位并结合延髓的解剖学特点,探讨延髓梗死临床表现的特征.方法:31例急性延髓梗死患者均行头颅MRI检查,对其病灶位置分布、神经系统症状体征,出院当天改良Rankin量表(mRS)评分等指标进行分析.结果:31例急性延髓梗死病例中:外侧延髓梗死(LMI)16例;内侧延髓梗死(MMI)13例;双侧延髓梗死(BMI)2例.LMI组病灶位于延髓背外侧或外侧;MMI组病灶位于延髓腹内侧,且多位于延髓上段.LMI多表现为不典型或部分性的"Wallenberg综合征",最常见的症状或体征为眩晕,Homer征、构音障碍、吞咽障碍、软腭麻痹,肢体共济失调.MMI多表现为感觉运动性卒中(SMS)或纯运动性卒中(PMS),最常见的症状或体征为对侧肢体偏瘫、构音障碍、中枢性面舌瘫.31例延髓梗死患者中,BMI 2例均为双侧MMI,其中1例出现四肢瘫痪、双侧肢体深浅感觉障碍、核间性眼肌麻痹、构音以及吞咽障碍,另1例表现为左侧肢体偏瘫、构音障碍、强哭、强笑等症状体征.结论:典型的延髓梗死综合征在临床上少见,LMI多表现为不典型,部分性的"Wallenberg综合征".而MMI往往与桥脑、基底节区腔隙性梗死的临床表现相似.双侧MMI导致四肢瘫痪等双侧锥体束受损表现,预后较差.     

延髓梗死的临床与神经影像学分析(附73例报告)

目的探讨延髓梗死的临床与神经影像学特点。方法回顾性分析73例延髓梗死患者的临床资料和影像学检查结果。结果本组男性53例,女性20例。首发临床表现复杂多样,其中浅感觉障碍41例,眩晕39例,饮水呛咳36例,恶心呕吐32例,吞咽困难31例,构音障碍29例。梗死病灶位于延髓上段27例,中段29例,下段12例,同时累及上段和中段3例,中段和下段2例。病灶位于背外侧61例,腹内侧10例,背内侧2例。表现为经典的延髓综合征共15例,包括Wallenberg综合征12例,Dejerine综合征1例,Avellis综合征1例,Babinski-Nageotte综合征1例。结论延髓梗死常见临床表现是浅感觉障碍和后循环缺血症状,经典延髓综合征少见;延髓梗死以中上段最常见,主要发生于背外侧;头部MRI对延髓梗死的诊断有极其重要的意义。     

脑桥梗死50例临床分析

目的根据头颅MRI对脑桥梗死病灶的定位,结合脑桥的解剖学特点,探讨脑桥梗死临床表现的特点。方法50例急性脑桥梗死均行头颅MRI检查,并对其病灶位置分布、神经系统体征、神经功能缺损程度（MRS评分）等指标进行分析。结果按头颅MRI横轴位上的病灶位置,50例脑桥梗死病例中：腹内侧梗死占48%,腹外侧梗死占32%,被盖部梗死占12%,双侧梗死占8%。在临床表现特点上,腹内、外侧梗死多表现为病灶对侧肢体偏瘫、中枢性面瘫以及构音障碍,同时伴或不伴肢体共济失调;脑桥被盖部梗死主要表现为脑神经瘫痪及感觉障碍;双侧脑桥梗死则往往表现为假性延髓性麻痹、双侧肢体运动障碍。腹内、外侧梗死起病后30 d MRS评分值较入院时明显改善（P〈0.01）,双侧脑桥梗死MRS评分值较其余各组高。结论脑桥梗死病灶多位于腹侧,且多表现为病灶对侧肢体瘫痪、中枢性面瘫以及构音障碍;脑桥梗死预后总体较好,不同梗死部位范围影响神经功能缺失程度。     

脑桥梗死50例临床分析

目的根据头颅MRI对脑桥梗死病灶的定位,结合脑桥的解剖学特点,探讨脑桥梗死临床表现的特点。方法50例急性脑桥梗死均行头颅MRI检查,并对其病灶位置分布、神经系统体征、神经功能缺损程度（MRS评分）等指标进行分析。结果按头颅MRI横轴位上的病灶位置,50例脑桥梗死病例中：腹内侧梗死占48%,腹外侧梗死占32%,被盖部梗死占12%,双侧梗死占8%。在临床表现特点上,腹内、外侧梗死多表现为病灶对侧肢体偏瘫、中枢性面瘫以及构音障碍,同时伴或不伴肢体共济失调;脑桥被盖部梗死主要表现为脑神经瘫痪及感觉障碍;双侧脑桥梗死则往往表现为假性延髓性麻痹、双侧肢体运动障碍。腹内、外侧梗死起病后30 d MRS评分值较入院时明显改善（P〈0.01）,双侧脑桥梗死MRS评分值较其余各组高。结论脑桥梗死病灶多位于腹侧,且多表现为病灶对侧肢体瘫痪、中枢性面瘫以及构音障碍;脑桥梗死预后总体较好,不同梗死部位范围影响神经功能缺失程度。     

后循环梗死的临床特点及危险因素分析

目的阐明后循环梗死常见临床症状、体征及危险因素。方法分析2008年10月-2011年10月在本院神经内科住院的急性后循环梗死患者61例资料。结果患者常见的症状头晕(54.1%)、偏侧肢体无力(45.9%)、恶心及呕吐(39.3%)和言语不清(31.1%);少见症状为视物成双(4.9%)、抽搐(4.9%)及记忆障碍(4.9%)。常见的体征为单侧或双侧肢体运动障碍(45.9%)、共济失调(29.5%)、交叉性瘫痪(3.3%)和眼球活动障碍(4.9%)。在所调查的危险因素中,高血压(72.1%)、高脂血症(63.9%)、糖尿病(36.1%)、既往卒中史(31.2%)及心脏病(27.9%)。结论后循环梗死临床表现复杂,常见的症状为头晕、偏侧肢体无力、恶心及呕吐、言语不清,常见体征为肢体运动障碍,高血压为后循环梗死的主要危险因素,特征性临床表现及体征有助于后循环梗死的诊断及治疗。     

延髓内侧综合征17例临床分析

延髓内侧综合征 (ＭｅｄｉａｌＭｅｄｕｌｌａｒｙＳｙｎｄｒｏｍｅ ,ＭＭＳ)是由于延髓内侧部位的梗死引起的神经系统疾病 ,其中部分患者的病变涉及延髓背侧的舌下神经核或舌下神经 ,出现病变侧舌肌瘫痪 ,病变对侧偏瘫及深感觉障碍。而多数患者可无舌肌瘫痪。经ＭＲＩ确诊为ＭＭＳ 17例的临床资料 ,报告如下。临床资料男 12例 ,女 5例。 38～ 75岁 ,平均 53岁 ,起病至就诊时间平均 2 1ｈ(2～ 96ｈ)。症状与体征 :17例ＭＭＳ患者中 ,肢体瘫痪是最常见的临床表现 ,13例为病变对侧偏瘫 ,1例为同侧偏瘫 ,3例为四肢瘫 ,瘫痪程度轻重不一。 5例瘫…     

延髓背外侧综合征22例临床分析

目的 分析延髓背外侧综合征的临床特征.方法 回顾性分析22例延髓背外侧综合征患者的临床资料.结果 本组均急性起病,以头晕、恶心、呕吐、同侧肢体共济失调、吞咽困难、饮水呛咳、构音障碍、Horner征、交叉性感觉障碍为常见临床表现.MRI检查22 例示延髓背外侧梗死;7例行血管检查,其中4例显示椎动脉狭窄或闭塞,2例显示小...     

后循环梗死102例临床分析

目的 探讨后循环梗死的临床特点.方法 选择后循环梗死219例,根据年龄分为青年组(12例)、中年组(105例)、老年组(102例).对比分析后循环梗死各年龄组临床症状、体征、梗死部位、责任血管、并发症.结果 后循环梗死各年龄组最常见的临床症状为头晕/眩晕,其后依次为行走不稳、言语不清、肢体无力等,3组间比较差异无统计学意义(P＞0.05).各年龄组最常见的临床体征为肢体共济失调,其后依次为肢体瘫痪、延髓性麻痹、脑神经麻痹,3组间比较差异无统计学意义(P＞0.05).各年龄组最常见的梗死部位为桥脑,次为小脑、中脑、延髓、枕叶、丘脑、颞叶内侧,3组间比较差异无统计学意义(P＞0.05);老年PCI责任血管发生动脉硬化狭窄、闭塞显著高于中、青年组(P＜0.05～0.01);老年PCI肺炎发生率最高,显著高于中、青年组(P＜0.01).结论 老年后循环梗死时责任血管更易硬化狭窄、闭塞,同时也更易并发肺炎,应针对性治疗、护理与康复措施.     

延髓“Y型”梗死1例报告(附文献复习)

<正>延髓位于脑干的最下端,较脑干其他部位血供丰富,所以延髓发生梗死的机会相对较少。如发生延髓梗死则以延髓背外侧为主,延髓内侧梗死少见,仅占脑卒中的0.5%¹.5%[1,2],双侧延髓内侧梗死更为罕见,其典型影像学表现为"心型"或"Y型"梗死,现将发现1例报道如下。1临床资料患者,男,52岁。因头晕10 h,言语不清伴右侧肢体活动不灵4 h,发作性左侧肢体活动不灵3.5 h入院。患者于入院当天10:00时无明显诱因出现头晕、头沉,未予注意,下午     

75例不典型脑干梗死临床观察

目的观察不典型脑干梗死患者的临床表现、梗死部位与影像学特点。方法 75例患者,发病7d内均给予1~2次头部磁共振检查(德国西门子1.5T),所有病例均给予平扫+DWI+ADC,脑干单一、新发病灶为入选标准,确保病灶为责任病灶;由两位神经内科医生进行病史的询问和体征检查,确保病史和体征的客观、真实。结果 75例不典型脑干梗死患者中,脑桥梗死发生率最高,中脑次之,延髓最少;临床表现以头晕或眩晕多见;体征以一侧中枢性面舌瘫及肢体瘫痪多见;影像学以点状、条索状、小斑片状梗死灶多见。结论脑干梗死临床表现复杂多样,经典综合征和交叉性表现有助于脑干梗死的诊断,但并不常见,临床上不典型脑干梗死更多见。     

Facial sensory symptoms in medullary infarcts

OBJECTIVE: To investigate the correlation between facial sensory abnormalities and lesional topography in eight patients with lateral medullary infarcts (LMIs). METHOD: We reviewed eight sequential cases of LMIs admitted to the Neurology Division of Hospital das Clínicas/S?o Paulo University between July, 2001 and August, 2002 except for one patient who had admitted in 1996 and was still followed in 2002. All patients were submitted to conventional brain MRI including axial T1-, T2-weighted and Fluid attenuated inversion-recovery (FLAIR) sequences. MRIs were evaluated blindly to clinical features to determine extension of the infarct to presumed topographies of the ventral trigeminothalamic (VTT), lateral spinothalamic, spinal trigeminal tracts and spinal trigeminal nucleus. RESULTS: Sensory symptoms or signs were ipsilateral to the bulbar infarct in 3 patients, contralateral in 4 and bilateral in 1. In all of our cases with exclusive contralateral facial sensory symptoms, infarcts had medial extensions that included the VTT topography. In cases with exclusive ipsilateral facial sensory abnormalities, infarcts affected lateral and posterior bulbar portions, with slight or no medial extension. The only patient who presented bilateral facial symptoms had an infarct that covered both medial and lateral, in addition to the posterior region of the medulla. CONCLUSION: Our results show a correlation between medial extension of LMIs and presence of contralateral facial sensory symptoms.     

Wallenberg综合征58例临床表现、CT及MRI分析

目的 探讨Wallenberg综合征的病因、临床表现、CT、MRI特点及预后。方法 对58例Wallenberg综合征患者的临床资料及CT、MRI特点进行分析。结果 57例(98．3％)患者为梗死所致，1例(1．7％)为左桥小脑角听神经鞘瘤。临床表现：多以眩晕、恶心、呕吐起病，以进展性形式多见。除了典型的WS的症状外，还可出现对侧面部及肢体浅感觉障碍、同侧面部及肢体感觉异常、深感觉障碍、眼球运动障碍、面瘫、项强等少见症状。头部CT扫描阳性率8．7％，头部MRI阳性率38．6％。5例在病后3～8d因心跳骤停死亡，经治疗吞咽困难、眩晕、恶心、声音嘶哑、眼震恢复较快，感觉障碍恢复最慢。结论 动脉粥样硬化致椎-基底动脉血栓形成是WS的主要病因但不是唯一原因。结合临床特点，对推测延髓病灶的大小、范围和受累的解剖结构有一定的临床意义。     

Vertigo and gait ataxia without usual signs of lateral medullary infarction: a clinical variant related to rostral-dorsolateral lesions

Isolated vertigo and ataxia have not been reported as manifestations of lateral medullary infarction. The author describes 3 patients with lateral medullary infarction who presented with almost isolated vertigo and gait ataxia without usual signs/symptoms of lateral medullary infarction such as facial/hemibody sensory changes, dysphagia, hoarseness, hiccup, limb ataxia, and Horner sign. Brain MRI showed small infarcts selectively involving the most dorsolateral portion of the rostral medulla that corresponds to the vestibulocerebellar pathway. These patients illustrate that lateral medullary infarction may present as an isolated vertigo and gait ataxia. Clinicians should be aware of this clinical variant, because these patients may be misdiagnosed as having labyrinthine disorders.     

Contralateral pharyngeal paralysis caused by medial medullary infarction

A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central facial palsy on the same side. Individual differences in supranuclear control of the pharyngeal muscles may explain this rare occurrence. The combination of these signs is described as a syndrome of upper medial medullary lesion.     

A case of bilateral lower pons-medial medullary infarction presenting quadriparesis]

Bilateral medial medullary infarction is rare. Only 18 cases have been reported previously. We experienced a case of the bilateral lower pons-medullary infarction. A 63-year-old woman was admitted to our hospital because of moderate left hemiparesis. Hyperreflexia in left limbs and positive Babinski's reflex in left foot was observed. Sensory disturbance was mild left hemihypesthesia (in light touch, postural sense and vibration) without facial involvement. She also had lateral gaze nystagmus, dysarthria, and bilateral decreased gag reflex. Respiratory failure was not observed. A conservative therapy for cerebral infarction was performed. But the hemiparesis was deteriorated and progressed to complete quadriparesis on the 5th day. The brain MRI (T2-weighted image and FLAIR) demonstrated bilateral lower pons-medial medullary infarction on the 9th day. Cerebral angiography and 3D-CT angiography revealed no stenosis or occlusions in the major cerebral arteries. The anterior spinal artery was not evaluated enough because of the arteriosclerosis. The prognosis of this patient was favorable except for the quadriparesis. The severe quadriparesis has not been improved for about 2 years. The bilateral medial medullary infarction was quite rare in the literature. The prognoses of these cases were unfavorable for the respiratory failure. Our case was not fatal because of no respiratory paralysis.     

The hemimedullary syndrome: case report and review of the literature

Summary Hemi-infarction of the medulla causes the clinical constellation of symptoms and signs of both the lateral and medial medullary syndromes and nearly always results from occlusion of an intracranial vertebral artery. In the case reported here, with a clinical diagnosis of hemimedullary syndrome, the expected infarction was imaged by magnetic resonance. A review of the literature confirms that the hemimedullary syndrome, in which both medial and lateral syndromes occur simultaneously, is extremely rare, since it yielded only two previous cases with adequate anatomical confirmation.     

Medial medullary syndrome with contralateral face hypalgesia: A report of two cases.

Classically, patients with unilateral medial medullary syndromes show contralateral deep sensory loss, contralateral hemiparesis, and ipsilateral tongue paralysis. We encountered two patients with medial medullary syndromes showing hypalgesia of the contralateral face. Both patients had contralateral deep sensory loss and hemiparesis, but no hypoglossal nerve palsy, so it was difficult to establish a medial medullary syndrome from the clinical neurological signs alone. Magnetic resonance images showed that the infarcted areas were located in the ventromedial area of the upper medulla, probably involving the trigeminothalamic tract in the medial lemniscus. We reviewed the reported cases of medial medullary syndromes and summarized their clinical features as well as the topography concerned with the associated sensory disturbances.