双侧延髓内侧梗死13例临床特点

摘要

目的 分析双侧延髓内侧梗死(bilateral medial medullary infarction,BMMI)的临床特点.方法 回顾性分析13例BMMI患者的临床资料、头颅磁共振特点及预后情况.结果 患者常见的临床表现为四肢瘫痪13例、头晕10例、舌肌瘫痪8例、构音障碍8例,严重的可伴有呼吸困难3例.病程呈急性进展性加重,疾病达峰时间为起病第3~6天,3个月随访10例中重度以上残疾.高危因素为高血压病、高脂血症和糖尿病.磁共振弥散加权成像(diffusion weigh imaging, DWI)显示延髓病灶呈特征性"Y"字型(6例)和"心"型(6例)的高信号影,磁共振血管成像提示一侧椎动脉重度狭窄10例.结论 BMMI是临床罕见的脑血管病,预后较差,头颅磁共振DWI具有重要的早期诊断价值.%Objective To investigate the clinical characteristics of bilateral medial medullary infarction (BMMI). Methods The clinical data, cranial magnetic resonance imaging (MRI) and prognosis at 3 months follow-up of 13 patients with BMMI were analyzed, retrospectively. Results The common symptoms and signs of BMMI were quadriplegia in 13 cases), dizzy in 10 cases, dysarthria in 8 cases, hypoglossal nerve palsy in 8 cases)and dyspnea in 3 severe cases. The disease had an acute onset with rapid progress and reached peak between day 3 and 6. There were ten cases with moderate to severe disability at 3 months follow-up. The risk factors were hypertension, hyperlipidemia and diabetes. MRI diffusion weighted imaging showed hyperintense signals in the bilateral medial medulla with classical "heart-"shape (6 cases) and "Y-" shape (6 cases). Magnetic resonance angiography showed unilateral vertebral artery stenosis or occlusion in most patients. Conclusion BMMI is a rare cerebrovascular disease with a poor outcome. MRI diffusion weighted imaging is of great value in the early diagnosis.