Kim Jong S
Department of Neurology, Asan Medical Center, Song-Pa PO Box 145, Seoul 138-600, South Korea.
Brain. 2003 Aug;126(Pt 8):1864-72. doi: 10.1093/brain/awg169. Epub 2003 May 21.
Although there have been attempts to make clinical-MRI correlation in patients with lateral medullary infarction (LMI), studies with a large number of patients are unavailable. In this study, clinical features, MRI findings and angiogram results of 130 acute, consecutive patients with pure LMI were studied and correlated. MRI-identified lesions were classified rostro-caudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. The distribution of horizontal subtypes was significantly different (P <0.001) among three rostro-caudal lesions in that rostral lesions tend to be ventral types and caudal lesions are lateral types. Patients with rostrally located lesions had dysphagia, facial paresis (P < 0.01, each) and dysarthria (P < 0.05) significantly more often, and severe gait ataxia and headache (P < 0.05, each) less often than those with caudal lesions. The frequencies of dysphagia (P < 0.01), dysarthria (P < 0.01) and bilateral trigeminal sensory pattern (P < 0.05) were significantly different among horizontal subtypes in that these symptoms were frequent in patients with "large type" as compared with those with lateral type lesions. Angiograms performed in 123 patients showed vertebral artery (VA) disease in 67% and posterior inferior cerebellar artery (PICA) disease in 10%. The presumed pathogenetic mechanisms included large vessel infarction in 50%, arterial dissection in 15%, small vessel infarction in 13% and cardiac embolism in 5%. Dissection occurred more often in patients with caudal (versus rostral) lesions (P < 0.01), whereas dorsal type infarcts (versus other types) were related more often to cardiogenic embolism and normal angiogram findings (P < 0.05, each). Patients with isolated PICA disease (versus those with VA disease) more often had cardiogenic embolism (P < 0.05) and less often had dissection (P < 0.01). It is concluded that rostro-caudal and horizontal classification of MRI helps us to understand the clinical and, partly, the aetiopathogenetic aspect of the heterogeneous LMI syndrome.
尽管已有研究尝试对延髓外侧梗死（LMI）患者进行临床与磁共振成像（MRI）的相关性分析，但尚无大量患者参与的研究。在本研究中，对130例连续的急性单纯LMI患者的临床特征、MRI表现及血管造影结果进行了研究并相互关联。MRI识别出的病灶按头尾方向分为头侧、中间和尾侧，按水平方向分为典型、腹侧、大片、外侧和背侧。水平亚型的分布在三个头尾方向的病灶之间存在显著差异（P<0.001），其中头侧病灶倾向于腹侧型，尾侧病灶为外侧型。与尾侧病灶患者相比，头侧病灶患者吞咽困难、面部轻瘫（均P<0.01）和构音障碍（P<0.05）的发生率显著更高，而严重步态共济失调和头痛（均P<0.05）的发生率更低。水平亚型之间吞咽困难（P<0.01）、构音障碍（P<0.01）和双侧三叉神经感觉模式（P<0.05）的发生率存在显著差异，因为与外侧型病灶患者相比，“大片型”患者出现这些症状的频率更高。对123例患者进行的血管造影显示，67%的患者存在椎动脉（VA）病变，10%的患者存在小脑后下动脉（PICA）病变。推测的发病机制包括大动脉梗死占50%、动脉夹层占15%、小血管梗死占13%和心脏栓塞占5%。夹层在尾侧（与头侧相比）病灶患者中更常见（P<0.01），而背侧型梗死（与其他类型相比）更常与心源性栓塞和血管造影正常结果相关（均P<0.05）。孤立性PICA病变患者（与VA病变患者相比）心源性栓塞更常见（P<0.05），夹层更少见（P<0.01）。结论是，MRI的头尾和水平分类有助于我们了解异质性LMI综合征的临床情况以及部分病因发病机制方面。
