延髓内侧梗死的临床特征及其与血管病变关系的研究

Clinical characteristics of medial medullary infarction and their relationship with vascular lesions:a preliminary study

目的分析延髓内侧梗死(MMI)的临床特征,初步探讨其与血管病变的关系。方法选择有临床症状并经MRI证实的单纯MMI患者18例,其中10例接受头部CT血管成像检查,4例接受全脑DSA检查。观察患者的临床和影像学表现,以及MMI与脑血管病变的关系。结果①18例中,病变单纯累及延髓内侧的腹侧6例(主要引起对侧肢体运动障碍)、中部2例(主要引起感觉障碍)、背侧4例(主要引起眼球震颤及眩晕);其余6例损害整个延髓内侧。②有15例在T1加权成像(T1WI)、T2加权成像(T2WI)及弥散加权成像上均发现病灶;有2例只在T2WI上发现病灶;1例患者的T1WI、T2WI呈等信号,1周后复查MRI,在T2WI发现病灶。③18例MMI患者中,合并糖尿病者8例,其中6例接受CT血管成像/DSA检查,均未见椎动脉病变。不合并糖尿病者10例(均合并高血压及低密度脂蛋白升高),其中8例接受CT血管成像/DSA检查,7例发现有椎动脉病变。结论 MMI主要损害延髓腹侧。MRI是目前诊断延髓梗死的首选方法;在糖尿病基础上引起的小血管及椎动脉病变可能参与了MMI发病过程。

Objective To investigate the clinical characteristics of medial medullary infarction （MMI） and their relationship with vascular lesions. Methods Eighteen patients with clinical symptoms of MMI and confirmed by magnetic resonance imaging （MRI） were selected. Among them, 10 were performed head CTA examination, and 4 were performed cerebral panangiography. The clinical and imaging findings and the outcomes were observed. Results ①Among the 18 patients, the lesions in 6 patients only affected the medial-ventral part of medulla（ mainly causing contralateral limb movement disorder）, in 2 patients affected the central part of medulla oblongata （mainly causing sensory dysfunction）, and in 4 patients affected the dorsal side of medulla oblongata （ mainly causing nystagmus and dizziness）. The whole medial medulla were injured in the remaining 6 patients. ②The lesions were detected in 15 patients on T1WI, T2WI, and DWI sequences. The lesions were only detected in 2 patients on T2WI sequence. One patient showed equal signal on T1WI, T2WI, and a lesion was detected on T2WI one week after MRI reexamination. ③Among the 18 patents with MMI, 8 were complicated with diabetes. Six of them performed CTA/DSA examinations, and no vertebral artery lesions were detected. Ten patients were not complicated with diabetes （all with hypertension and elevated low-density lipoprotein）, and 8 of them performed CTA/ DSA examinations, and the vertebral artery lesions were detected in 7 patients. Conclusions MMI mainly damages the ventral part of medulla ohlongata. MR/is a preferred method at present in the diagnosis of medullary infarction. Diabetes causes small vascular disease and vertebral artery disease may participate the pathogenic process of MMI.