我国双侧延髓内侧梗死139例临床分析

Clinical analysis of 139 Chinese patients with bilateral medial medullary infarction

目的探讨我国双侧延髓内侧梗死(bilateral medial medullary infarction,BMMI)患者的临床特点、影像学表现、治疗及转归情况,以期提高临床医生对BMMI的认识。方法回顾性分析1991—2022年国内期刊公开报道的BMMI病例的临床表现、影像学结果、诊治经过及预后情况。结果本文共纳入72篇文献,139例BMMI患者被纳入分析,其年龄范围为24~94岁,男女比例约为3∶1。最常见的临床症状为不同程度的肢体乏力[96%(133/139)]。影像学结果显示患者延髓病灶主要呈“Y”型、“心”型等改变。71%(78/110)患者存在椎基底动脉粥样硬化改变。只有3例患者进行了溶栓治疗。25%(31/124)患者无明显好转,5%(6/124)患者死亡。BMMI早期误诊率达12%(17/139),最易被误诊为吉兰-巴雷综合征。结论BMMI临床表现多样,易被误诊、漏诊,且预后差,头颅MRI有助于早期诊断。临床医师应提高对BMMI的认识,促使患者得到及时诊治,积极处理并发症,改善患者预后。

Objective To investigate the clinical manifestations,neuroradiological features,treatment,and prognosis of bilateral medial medullary infarction(BMMI)in China,so as to improve clinicians'understanding of BMMI.Method The clinical data of BMMI cases reported in domestic journals from 1991 to 2022 were retrospectively analyzed,including clinical characteristics,imaging findings,treatment,and prognosis.Results A total of 72 articles were included in this study,and 139 patients with BMMI were collected for analyses.The age of the included cases ranged from 24 to 94 years old,and the ratio of males to females was about 3:1.The most common clinical symptom was motor weakness of limbs[96%(133/139)].The neuroimaging results revealed that the lesions in the medulla oblongata mainly showed"Y appearance"or"heart appearance",and 71%(78/110)of the patients were observed with vertebrobasilar atherosclerosis.Only 3 patients received thrombolytic therapy.Of the patients,25%(31/124)did not achieve clinical improvement,and 5%(6/124)died.The misdiagnosis rate of BMMI was 12%(17/139),and patients with BMMI were most easily misdiagnosed as Guillain-Barre syndrome.Conclusions The clinical manifestations of BMMI are diverse,and it is easy to be misdiagnosed and miss diagnosed,usually with poor prognosis.Brain MRI is helpful for early diagnosis.Clinicians should be aware of BMMI,and help patients get proper treatment in time so as to improve their clinical outcomes.