延髓背外侧综合征的临床及影像学分析

Clinical and Imaging Analysis of Lateral Medullary Syndrom

目的:探索延髓背外侧综合征(又称Wallenberg综合征)的临床与影像学特征。方法:对2000年1月—2008年10月31例Wallenberg综合征患者的临床资料进行回顾分析。结果:Wallenberg综合征的主要临床主要表现为眩晕、头晕、恶心、呕吐、眼球震颤、交叉性感觉障碍、同侧Horner征、饮水呛咳、吞咽困难和声音嘶哑、同侧小脑性共济失调及呃逆。磁共振成像(MRI)显示位于延髓上部12例(38.7%);延髓中部9例(29%);延髓下部10例(32.3%);6例伴小脑梗死。18例磁共振血管成像(MRA)显示12例一侧椎动脉(vertebralartery,VA)变细或消失,其中2例伴基底动脉狭窄。数字减影血管造影(DSA)显示椎动脉、小脑后下动脉及基底动脉狭窄或闭塞。结论:临床表现和MRI表现是诊断Wallenberg综合征的主要依据,DSA能为病变提供血管定位依据。MRI普遍性应用对Wallenberg综合征的早期诊断、早期治疗及早期预防起重要作用。

Objective： To explore the clinical and imaging features of lateral medullary syndrome （Wallenberg syndrome）. Methods： The clinical data of 31 patients with Wallenberg syndrome from Jan. 2000 to Oct. 2008 were retrospectively analyzed. Results： The main clinical manifestations of the patients with Wallenberg syndrome were vertigo, dizziness, nausea, vomiting,nystagmus, crossed sensory dysfunction, ipsilateral Horner sign, dysphagia, hoarseness, ipsilateral cerebellar ataxia of limbs and hiccup. Magnetic resonance imaging （MRI） showed that the lesion of 12 cases was located on the upper part of oblongata medulla （38.70%）; 9 cases on the central part of it （29%）; 10 cases on the lower part of it（32.3%）;6 patients with cerebellum infarction, magnetic resonance angiography（MRA） of 18 cases showed 12 cases of them are with one vertebral artery stenosis or disappeared. Two of cases with BA stenosis. DSA showed vertebral artery（VA）, posterior inferior eerebellar artery （PICA） and basilar artery（BA） were stenosis or occlusion. Conclusion.. The clinical manifestation and MRI showing are the main basis for diagnosis of Wallenherg syndrome. DSA can provide the evidence for vascular location. The universal applying of MRI plays an important role on early diagnosis, early treatment and early prevention for Wallenberg syndrome.