Segura T, Broseta L, Rallo B, Villanueva P, Zorita M D
Sección de Neurología, Hospital General de Albacete, Hermanos Falcó, s/n. E-02006, Albacete.
Rev Neurol. 2000;31(10):944-6.
Isolated bulbar infarcts are infrequent. Because of the vascular anatomy the lateral region is the most commonly affected, and in this clinical disorder the various signs and symptoms are grouped together as the so-called Wallenberg's syndrome. Since the introduction of magnetic resonance (MR) it has been possible to correlate the extent and site of the laterobulbar area involved with the most probable vascular topography and etiopathogenesis.
We describe the case of a 69 year old female patient with all the symptoms of Wallenberg's syndrome and two potential causes of stroke (emboliogenic cardiopathy and atherothrombotic vascular occlusion), in whom MR showed the presence of an isolated bulbar lesion of unusual morphology which had previously been described as being of thrombotic origin.
In spite of the small area of the brain involved, in laterobulbar infarcts MR permits definition of different topographic patterns of ischemic lesions. Some of these patterns have been correlated with the specific aetiology of an infarct. Therefore there is twice the importance of cerebral MR in cases of suspicion of lateral bulbar ischaemia, since it not only assists in diagnosis and its clinicopathological correlations, but also, as in our case, helps to have a clinical suspicion of the most likely etiopathogenesis of the stroke.
孤立性延髓梗死并不常见。由于血管解剖结构的原因，外侧区域是最常受累的部位，在这种临床病症中，各种体征和症状被归为所谓的延髓背外侧综合征。自从磁共振成像（MR）应用以来，已经能够将延髓外侧区域受累的范围和部位与最可能的血管形态及病因联系起来。
我们描述了一名69岁女性患者的病例，她具有延髓背外侧综合征的所有症状以及两种可能的中风病因（栓子源性心脏病和动脉粥样硬化血栓形成性血管闭塞），其磁共振成像显示存在一个形态异常的孤立性延髓病变，此前曾被描述为血栓形成起源。
尽管受累脑区面积较小，但在延髓外侧梗死中，磁共振成像能够明确缺血性病变的不同形态学模式。其中一些模式与梗死的特定病因相关。因此，在怀疑延髓外侧缺血的病例中，脑部磁共振成像具有双重重要性，因为它不仅有助于诊断及其临床病理相关性分析，而且如我们的病例所示，还有助于临床怀疑中风最可能的病因。
