延髓背外侧综合征的临床及影像学研究

Clinical and imaging study in Lateral Medullary Syndrome

目的探讨延髓背外侧综合征(lateral medullary syndrome,LMS)的临床及影像学特点。方法回顾性分析26例延髓背外侧综合征的临床及影像学资料。结果26例均急性或亚急性起病,首发症状为头晕、言语不清、吞咽困难者22例,占84.6%。常见的临床表现有吞咽困难、声音嘶哑、饮水呛咳(88.5%);眩晕、呕吐、眼震(76.9%);共济失调(61.5%);Horner征(53.8%)以及交叉性感觉障碍(50.0%)。MRI以延髓背外侧长T1长T2信号为主要影像学特征。26例患者经治疗均好转出院,其中痊愈6例(23.7%)20例遗留有一定的后遗症,包括咽反射减弱6例,共济失调5例,感觉障碍5例,轻度Horner征3例,轻度周围性面瘫1例。结论延髓背外侧综合征首发症状多为头晕、言语不清、吞咽困难。MRI检查对诊断的敏感性高。早期诊断、早期治疗、预防并发症的发生是改善预后的关键。

Objective To explore the clinical and imaging of Lateral Medullary Syndrome （LMS）. Methods 26 cases of lateral medullary syndrome were analyzed retrospectively. Results The patients presented acute or subacute onset, 22 cases have the first symptom of dizziness, unclear speech, difficulty swallowing, accounting for 84.6 percent. Dysphagia, hoarse voice, choking drinking water （88.5%） ; dizziness, vomiting, nystagmus （76.9%） ; Ataxia （61.5%） ; Homer levy （53.8%） and cross-sexual dysfunction （50.0%） were the most common symptoms and signs. The MRI image of all cases was indications that the lateral medullary have long T1 and long T2 signal. All of patients receiving treatment are better discharge, which recovered six cases （23.7%） . 20 patients have left the after-effects, which swallow reflex weakened 6 cases , Ataxia 5 cases, 5 cases of sensory dysfunction, mild Homer levy 3 cases, 1 case of peripheral facial paralysis. Conclusion The most first symptom of Lateral Medullary Syndrome are dizziness, speech unclear, dysphagia, MRI is sensitive for the diagnosis of LMS. Early diagnosis and treatment, prevention of the occurrence of complications is the key to improve the prognosis of LMS.