“Y” 形及半 “Y” 形延髓梗死的临床特点及影像学对比分析

摘要： 目的 探讨 “Y” 形及半 “Y” 形延髓梗死患者的临床和影像学特点, 并对两者的临床特点进行对比分析。方法 对我院神经内科收治的11例延髓腹、 中及背三部分 （VMD） 同时发生梗死的延髓内侧梗死 （MMI） 患者进行回顾性分析。结果 11例累及VMD的MMI患者中, 6例发生双侧梗死, 呈 “Y” 形; 单侧梗死者5例, 呈半 “Y” 形。延髓 “Y” 形梗死组常见的症状和体征为饮水呛咳或吞咽困难 （6例）、 头晕或眩晕、 肢体无力、 构音障碍 （5例）、 感觉障碍 （5例）、中枢性呼吸障碍 （3例） 等。延髓半 “Y” 形梗死组常见的症状和体征为头晕或眩晕、 肢体无力、 构音障碍 （4例）、 感觉障碍 （4例） 等, 2组间吞咽困难及呼吸困难发生比例差异明显。“Y” 组和半 “Y” 组梗死存在椎动脉先天变异均较常见, 均为3例。MMI患者除呼吸衰竭者外预后可。结论 延髓 “Y” 形梗死患者出现吞咽困难及呼吸衰竭比例远高于延髓半 “Y” 形梗死患者, 一侧椎优势的椎动脉变异是VMD同时受累的MMI患者的重要解剖基础。

Comparative analysis of clinical and imaging features of "Y" shape and half "Y" shape medullary infarction

Abstract：Objective To investigate the clinical and imaging features of the "Y" shape and half "Y" shape medullary infarction in patients with medullary infarction. Methods The clinical and imaging findings of 11 patients with medial medullary infarction (MMI) in the ventral, middle and dorsal (VMD) parts of the medulla oblongata were retrospectively analyzed. Results There were 11 MMI patients with VMD involvement in this study. Of them there were 6 cases with bilateral infarction, showing the "Y" shape and 5 patients with unilateral infarction, showing half "Y"-shape. In "Y"-shaped group, the most common symptoms and signs were drinking cough or dysphagia (6 cases), dizziness or vertigo (5 cases), limb weakness (5 cases), dysarthria (5 cases), sensory disorders (5 cases) and central respiratory disorders (3 cases). In the half "Y" shape group, the most common symptoms and signs were dizziness or vertigo (5 cases), limb weakness (4 cases), dysarthria (4 cases) and sensory impairment (4 cases). There was a significant difference in the proportion of dysphagia and dyspnea between the two groups. The congenital variation of vertebral artery was more common in two groups of patients (n=3 for both groups). In addition to respiratory failure, the outcomes of MMI patients were favorable. Conclusion The frequency of dysphagia and respiratory failure is much higher in patients with "Y"-shaped medullary infarction compared with that in patients with half "Y"-shaped infarction of medulla oblongata. Vertebral artery variation with one-sided superiority is an important anatomical basis for MMI patients with VMD involvement at the same time.