Chen Chien-Ming, Huang Tzu-Ying
Department of Internal Medicine, Feng Yuan Hospital, Department of Health, Executive Yuan, Taichung, Taiwan.
Acta Neurol Taiwan. 2008 Dec;17(4):239-42.
Palatopharyngeal paresis has never been reported to be contralateral in the lateral medullary infarction (LMI). A 65-year-old lady with acute dorsolateral infarction in the left medulla presented mild hoarseness, mild dysphagia, mild gait ataxia along with marked hypalgesia and thermal anesthesia on the right limbs. To our surprise, palatal weakness was on the right side, instead of being on the left side as expected in typical Wallenberg syndrome. The palatal paresis was noted during voluntary phonation but turned into normal movement while gag reflex was induced. An involvement of corticobulbar fibers before synapsing into the ipsilateral caudal medulla or a selective involvement of the peri-ambigual reticular formation and/or its post-synaptic connection fiber destined to the contralateral swallowing center presumably underlies such a rare contralateral palatal paresis.
延髓外侧梗死（LMI）导致的腭咽肌无力从未有过对侧受累的报道。一位65岁女性，左侧延髓急性背外侧梗死，表现为轻度声音嘶哑、轻度吞咽困难、轻度步态共济失调，同时右侧肢体有明显痛觉减退和温度觉缺失。令我们惊讶的是，腭部无力出现在右侧，而非典型延髓背外侧综合征（Wallenberg综合征）预期的左侧。在自主发声时可发现腭肌无力，但在诱发咽反射时腭部运动转为正常。推测这种罕见的对侧腭肌无力的潜在机制是皮质延髓纤维在突触连接到同侧延髓尾部之前受累，或疑核周围网状结构及其至对侧吞咽中枢的突触后连接纤维选择性受累。
