老年双侧延髓内侧梗死患者临床及影像学分析

Clinical and imaging characteristics of bilateral medial medullary infarction in elderly patients

目的探讨老年患者双侧延髓内侧梗死(BMMI)的临床特点。方法回顾性分析8例磁共振弥散加权像(DWI)上呈不同形态BMMI老年患者的临床及影像资料.所有患者经磁共振成像(MRI)检査确诊,4例行CT血管成像(CTA)及血管超声检查,4例行血管超声检查。结果8例(100.0%)患者均急性起病,呈不同程度的肢体瘫痪(7/8,87.5%)、头晕(5/8,62.5%)、构音障碍(6/8,80.0%)、吞咽困难(3/8,37.5%)、感觉障碍(5/8,62.5%)、复视(2/8,25.0%)、意识障碍(2/8,25.0%)、耳鸣(1/8,12.5%);病灶多位于延髓中上段(7/8,87.5%),横轴位DWI病灶呈倒"八”型3例(37.5%〉,"V”型1例(12.5%),“Y”型3例(37.5%),"心”型1例(12.5%);8例(100.0%)均合并后循环血管多发狭窄或闭塞;其中病灶“心”型、“Y”型患者病情呈进展性加重;治疗后基本痊愈4例(50.0%),好转3例(37.5%),1例未愈出院(12.5%)。结论BMMI老年患者多合并后循环动脉粥样硬化性狭窄,DWI呈“心”型及“Y”型患者病情易进展,预后差。头颅核磁结合DWI检查有助于早期临床诊断,预判病情演变,有效预防并发症。

Objective To investigate the clinical features of bilateral medial medullary infarction (BMMI) in elderly patients.Methods Clinical and imaging data of 8 elderly BMMI patients with different morphology on diffusion-weighted magnetic resonance imaging ( DWI-MR ) were retrospectively analyzed.All patients were diagnosed by MRI, while 4 patients received CTA and vascular ultrasound testing,and the other 4 patients received vascular ultrasound testing.Results All 8 cases( 100.0%) had acute-onset BMMI.Patients showed varying degrees of acroparalysis ( 7/8.87.5%),dizziness( 5/8,62.5%), dysarthria( 6/8,80.0%),dysphagia(3/8,37.5%), deep or superficial sensory dysfunction(5/8,62.5 %), consciousness disorders ( 2/8,25.0%), dyspnea( 2/8,25.0%), and tinnitus( 1/8,12.5%).Lesions in most patients were located in the upper part of medulla oblongata(7/8,87.5%).In the transverse direction of DWI.the lesions as the inverted V shape were seen in 3 cases (37.5%),the V shape( 12.5%)in 1 case, the Y shape(37.5%)in 3 cases,and the heart shape( 12.5%) in 1 case.All 8 patienls were complicated with posterior cerebral artery stenosis or occlusion,of whom patients with heart-or Y-shaped lesions showed progressive exacerbation.After treatment , 4 cases (50.0%) recovered, 3 cases( 37.5%) improved, and 1 case(12.5%) unrecovered before discharge from the hospital.Conclusions Most elderly BMMI patients have concurrenl posterior circulation artery stenosis,and patients with heart-or Y-shaped lesions on MR-DWI show rapid progression and have a poor prognosis.Cranial examination with MR-DWI is helpful for early clinical diagnosis of BMMI.prediction of disease progression and effective prevention of complications.