进展性双侧延髓内侧梗死的临床特征

Clinical characteristics of bilateral medial medullary infarction in progression

目的探讨进展性双侧延髓内侧梗死(BMMI)的临床特征。方法选择2021年12月14日和2022年5月9日经复旦大学附属中山医院青浦分院神经内科确诊的2例进展性BMMI患者的临床资料,总结BMMI的诊断学特征,并复习相关文献。结果患者均为男性,年龄分别为50岁、40岁,病例1患者首发症状为头晕,病例2患者首发症状为头晕伴头颈疼痛。2例患者均于发病12 h内进展出现偏侧肢体乏力,并且在第2天偏侧肢体乏力进一步加重;随着病情进展,2例患者均出现构音障碍、吞咽困难;病例1患者在发病后1周出现四肢瘫痪。2例患者头颅磁共振成像(MRI)表现为双侧延髓内侧沿中线向背侧延伸的弥散加权成像(DWI)高信号病灶,外观类似“心”形或“Y”形,均确诊为BMMI。结论BMMI典型的临床表现为四肢瘫痪、吞咽困难、构音障碍、深感觉障碍等,该病首发症状多不典型,应尽早完善头颅MRI检查有利于早期诊断和指导治疗。

Objective To explore the clinical characteristics of progressive bilateral medial medullary infarction(BMMI).Methods The clinical data of two patients with progressive BMMI diagnosed in the Department of Neurology,Qingpu Branch of Zhongshan Hospital of Fudan University on December 14,2021 and May 9,2022 were chosen to summarize the diagnostic features of BMMI,and the relevant literatures were reviewed.Results The patients were all men between the ages of 50 and 40.Case 1 patient′s first symptom was dizziness,while case 2 patient′s first symptom was dizziness with head and neck pain.Both patients experienced lateral limb weakness within 12 hours of onset,which was exacerbated on the second day.As the disease progressed,both patients developed dysarthria and dysphagia.One week after onset,case 1 patient developed quadriplegia.Two patients were diagnosed with BMMI using head magnetic resonance imaging(MRI),which revealed high signal lesions extending along the midline to the dorsal side,resembling a"heart"or"Y"shape on diffusion weighted imaging(DWI).Conclusions Quadriplegia,dysphagia,dysarticulation,deep sensory disorders,and other clinical manifestations of BMMI are common.Because the early symptoms of this disease are mostly atypical,it is critical to improve the head MRI examination as soon as possible to facilitate early diagnosis and treatment guidance.