Wallenberg综合征58例临床表现、CT及MRI分析

Wallenberg syndrome:clinical analysis of 58 cases

目的 探讨 Wallenberg综合征的病因、临床表现、CT、MRI特点及预后。方法 对 5 8例 Wallenberg综合征患者的临床资料及 CT、MRI特点进行分析。结果 5 7例 (98.3% )患者为梗死所致 ,1例 (1.7% )为左桥小脑角听神经鞘瘤。临床表现 :多以眩晕、恶心、呕吐起病 ,以进展性形式多见。除了典型的 WS的症状外 ,还可出现对侧面部及肢体浅感觉障碍、同侧面部及肢体感觉异常、深感觉障碍、眼球运动障碍、面瘫、项强等少见症状。头部 CT扫描阳性率 8.7% ,头部 MRI阳性率 38.6 %。 5例在病后 3～ 8d因心跳骤停死亡 ,经治疗吞咽困难、眩晕、恶心、声音嘶哑、眼震恢复较快 ,感觉障碍恢复最慢。结论 动脉粥样硬化致椎 -基底动脉血栓形成是 WS的主要病因但不是唯一原因。结合临床特点 ,对推测延髓病灶的大小、范围和受累的解剖结构有一定的临床意义。

Objective The clinical manifestations of Wallenberg syndrome (WS) are very complex. The aim of the present study was to study pathogenic mechanisms and clinical features of Wallenberg syndrome. Methods We studied on the 58 cases who had clinical manifestations,CT and MRI findings consistent with Wallenberg syndrome. Results Pathogenic mechanisms of WS were vertebrobasilar artery atherothrombosis in 53 patients and cardiogenic embolism in 4 patients. Acoustical neurolemmoma was considered in one patients. There were some uncommon manifestations except classical clinical symptoms in our 58 cases:sensory symptoms in ipsilateral limbs/body,sensory symptoms in contralateral face and limbs/body;deep sensory dysfunction;facial paralysis;ocular motor abnormalities. Computed tomography (CT) was insufficient in evaluation of medullary lesions. Magnetic resonance imaging (MRI) was excellent for defining location of ischemic infarction in the medulla. Conclusion Various clinical findings of Wallenberg lateral medullary syndrome are correlated with diverse pathogenic mechanisms:etiology,location and size of the involved vessels,speed of the lesion development,and status of collateral channels.