Kim J S, Choi-Kwon S
Department of Neurology, University of Ulsan, Asan Medical Center and the College of Nursing, Seoul National University, Korea.
Stroke. 1999 Dec;30(12):2697-703. doi: 10.1161/01.str.30.12.2697.
A comparison between long-term sensory sequelae of lateral medullary infarction (LMI) and medial medullary infarction (MMI) has never been made.
We studied 55 patients with medullary infarction (41 with LMI and 14 with MMI) who were followed up for >6 months. We examined and interviewed the patients with the use of a structured format regarding the most important complaints, functional disabilities, and the presence of sensory symptoms. The nature and the intensity of sensory symptoms were assessed with the modified McGill-Melzack Pain Questionnaire and the visual analog scale, respectively.
There were 43 men and 12 women, with an average age of 59 years. Mean follow-up period was 21 months. The sensory symptoms were the most important residual sequelae in LMI patients and the second most important in MMI patients. In LMI patients, the severity of residual sensory symptoms was significantly related to the initial severity of objective sensory deficits (P<0.05). Sensory symptoms were most often described by LMI patients as numbness (39%), burning (35%), and cold (22%) in the face, and cold (38%), numbness (29%), and burning (27%) in the body/limbs, whereas they were described as numbness (60%), squeezing (30%) and cold (10%), but never as burning, in their body/limbs by MMI patients. LMI patients significantly (P<0.05) more often cited a cold environment as an aggravating factor for the sensory symptoms than did the MMI patients without spinothalamic sensory impairment. The subjective sensory symptoms were frequently of a delayed onset (up to 6 months) in LMI patients, whereas they usually started immediately after the onset in MMI patients.
Our study shows that sensory symptoms are major sequelae in both LMI and MMI patients. However, the nature, the mode of onset, and aggravating factors are different between the 2 groups, which probably is related to a selective involvement of the spinothalamic tract by the former and the medial lemniscus by the latter. We suggest that the mechanisms for the central poststroke pain or paresthesia may differ according to the site of damages on the sensory tracts (spinothalamic tract versus medial lemniscal tract).
从未对延髓外侧梗死（LMI）和延髓内侧梗死（MMI）的长期感觉后遗症进行过比较。
我们研究了55例延髓梗死患者（41例LMI患者和14例MMI患者），随访时间超过6个月。我们采用结构化形式对患者进行检查和访谈，内容涉及最重要的主诉、功能障碍以及感觉症状的存在情况。分别使用改良的麦吉尔 - 梅尔扎克疼痛问卷和视觉模拟量表评估感觉症状的性质和强度。
患者中有43名男性和12名女性，平均年龄59岁。平均随访期为21个月。感觉症状是LMI患者最重要的残留后遗症，是MMI患者第二重要的残留后遗症。在LMI患者中，残留感觉症状的严重程度与客观感觉缺陷的初始严重程度显著相关（P<0.05）。LMI患者最常描述的感觉症状是面部麻木（39%）、灼痛（35%）和冷感（22%），身体/四肢冷感（38%）、麻木（29%）和灼痛（27%），而MMI患者将身体/四肢的感觉症状描述为麻木（60%）、挤压感（30%）和冷感（10%），但从未描述为灼痛。与没有脊髓丘脑束感觉障碍的MMI患者相比，LMI患者更常将寒冷环境视为感觉症状的加重因素（P<0.05）。LMI患者的主观感觉症状通常起病延迟（长达6个月），而MMI患者的感觉症状通常在发病后立即出现。
我们的研究表明，感觉症状是LMI和MMI患者的主要后遗症。然而，两组患者感觉症状的性质、起病方式和加重因素不同，这可能与前者选择性累及脊髓丘脑束、后者累及内侧丘系有关。我们认为，卒中后中枢性疼痛或感觉异常的机制可能因感觉传导束（脊髓丘脑束与内侧丘系传导束）损伤部位的不同而有所差异。
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