双侧延髓内侧梗死的临床和影像学特征

Clinical and imaging features of bilateral medial medullary infarction

目的探讨双侧延髓内侧梗死(BMMI)的临床和影像学特征。方法对20例BMMI患者的临床资料进行回顾性分析。结果 20例患者首发症状为头晕6例(30%),四肢无力6例(30%),单侧肢体无力4例(20%),吞咽困难3例(15%),双下肢无力1例(5%)。本组患者均为急性起病,16例进展性加重;20例患者均出现不同程度的四肢瘫痪,吞咽困难17例,构音障碍15例,头晕13例,舌瘫11例,水平眼震7例,呼吸困难8例,双侧深感觉障碍8例,双侧Babinski征阳性16例。20例颅脑MRI均示BMMI,18例DWI示双侧延髓内侧高信号,10例头颅MRI双延髓内侧见T1低信号、T2高信号。20例患者中有8例患者MRA、CTA或DSA见椎动脉的远端局限性的狭窄或闭塞。治疗后基本痊愈7例。结论 BMMI表现为急起四肢瘫痪,两侧基本对称,双侧锥体束征,常有迷走神经、舌下神经受累症状及双侧深感觉障碍。头颅MRI结合DWI成像检查有助于早期诊断,积极治疗多数患者预后良好。

Objective To Investigate the clinical and imaging features of bilateral medial medullary infarction （ BMMI） .Methods The clinical data of 20 BMMI patients were analyzed retrospectively.Results In 20 cases, the initial symptom was dizzy in 6 cases （ 30%） , quadriplegia in 6 cases （ 30%） , hemiplegic paralysis in 4 cases （20%）, dysphagia in 3 cases （15%）, weakness of lower limbs in 1 cases （5%）.All 20 cases were acute onset, progressive in 16 cases.The main clinical features were shown that 20 cases demonstrated quadriplegia, 17 cases dysphagia, 15 cases dysarthria, 13 cases vertigo, 11 cases tongue atrophy, 7 cases horizontal nystagmus, 8 cases difficulty breathing, 8 cases deep sensory disturbance, 16 cases bilateral babinski sign positive.Twenty cases of brain MRI show bilateral medial medullary infarction, DWI found increased signal intensity in double inside of the medulla oblongata in 18 cases, MRI T1 showed decreased signal and T2 showed increased signal in double inside of the mudullary infarction in 10 cases.MRA, CTA and DSA showed hemadostenosis and vascular occlusion in the vertebral artery in 8 cases.Seven cases were benign after treatment and could walk independly.Conclusions The clinical manifestation of BMMI are quadriplegia on acute onset, and bilateral synmetry, bilateral pyramid sign, impaired vagus nerve, hypoglossal nerve and deep feeling.Brain MRI with DWI examination is helpful for early diagnosis, and most patients with active treatment could get good prognosis.