双侧延髓内侧梗死临床诊治二例并文献复习

Bilateral medial medullary infarction: a report of two cases and literature review

双侧延髓内侧梗死(MMI)是一种罕见的后循环卒中类型,发病早期易被误诊为吉兰-巴雷综合征等疾病,总体预后较差。迫切需要对其早期诊断和正确治疗。作者对诊断为双侧MMI的两例患者病历资料进行总结:均急性发作,其中1例患者具有急性吉兰-巴雷综合征样症状(快速进展性四肢瘫痪和发音困难),另1例患者以双侧肢体无力及麻木为主要表现。临床医师根据症状、体征和发病模式(急性发作,特别是在睡眠期间发作或睡眠期间迅速恶化)等特点,结合扩散加权成像,快速做出正确的诊断。由于早期给予强化三联抗血小板聚集药物(阿司匹林+氯吡格雷+替罗非班)治疗,两例患者初期均迅速好转。本研究旨在通过报道其临床表现、神经影像学特征和治疗体会,以为神经内科临床医师早期诊断和有效治疗提供参考。

Bilateral medial medullary infarction(MMI)is a rare type of posterior circulation stroke,which is easily misdiagnosed as Guillain-Barr syndrome,myelitis,and other diseases in the early stages of onset,and has a poor overall prognosis.Early diagnosis and correct treatment are urgently needed.The authors reviewed two patients recently diagnosed with bilateral MMI.Both patients suffered from acute attacks,with one patient suffering from acute Guillain-Barr syndrome like symptoms(rapid progressive quadriplegia and difficulty in pronunciation),and the other patient presenting mainly with bilateral limb weakness and numbness.Experienced clinicians can quickly make accurate diagnoses by collecting information such as medical history,symptoms,signs,and patterns of onset(acute attacks,especially during sleep or rapid deterioration during sleep),combined with diffusion weighted imaging.With early intensified triple antiplatelet therapy,symptoms of both patients relieved rapidly.The aim of this study is to describe the mechanism,clinical manifestations,neuroradiological features and treatment of stroke,to provide reference for early diagnosis and effective treatment.