Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan.
J Stroke Cerebrovasc Dis. 2012 Oct;21(7):594-9. doi: 10.1016/j.jstrokecerebrovasdis.2011.01.008. Epub 2011 Mar 4.
Clinical features of medullary infarction were compared between patients with lateral medullary infarction and medial medullary infarction
Thirty-seven patients with medullary infarction (29 with lateral medullary infarction and 8 with medial medullary infarction) who were admitted to our center between April 1, 2007 and March 31, 2010 were examined. Background factors, neurologic signs and symptoms, imaging findings, cause of disease, and outcomes were assessed for patients with lateral and those with medial medullary infarction.
Examination of the clinical symptoms and neurologic findings suggested that among patients with medial medullary infarction, few demonstrated all of the symptoms of Dejerine syndrome at onset, and many had lesions that were difficult to locate based only on neurologic findings. Both lateral and medial medullary infarction were frequently caused by atherothrombosis. However, cerebral artery dissection was observed in 31% of patients with lateral medullary infarction and 12.5% of those with medial medullary infarction. In 13% of patients with lateral and 37% of patients with medial medullary infarction, magnetic resonance imaging diffusion-weighted images on the day of onset did not show abnormalities, and the second set of diffusion-weighted images confirmed infarction lesions. For lateral medullary infarction, a more rostral lesion location was correlated with a poorer 90-day outcome. For medial medullary infarction, a more dorsal lesion location was correlated with a poorer 90-day outcome.
The diagnosis rate of medullary infarction using imaging examinations at onset--particularly medial medullary infarction--is not necessarily high. The imaging examinations need to be repeated for patients who are suspected to have medullary infarction based on neurologic signs and symptoms.
比较了外侧和内侧延髓梗死患者的临床特征
对 2007 年 4 月 1 日至 2010 年 3 月 31 日期间在我院住院的 37 例延髓梗死患者（29 例外侧延髓梗死和 8 例内侧延髓梗死）进行了检查。评估了外侧和内侧延髓梗死患者的背景因素、神经体征和症状、影像学发现、病因和结局。
检查临床症状和神经发现表明，内侧延髓梗死患者中，很少有患者在发病时出现 Dejerine 综合征的所有症状，许多患者的病变仅根据神经发现难以定位。外侧和内侧延髓梗死均常由动脉粥样硬化血栓形成引起。然而，外侧延髓梗死患者中有 31%、内侧延髓梗死患者中有 12.5%存在脑动脉夹层。外侧延髓梗死患者中有 13%、内侧延髓梗死患者中有 37%在发病当天磁共振弥散加权成像未见异常，第二组弥散加权成像证实存在梗死病灶。对于外侧延髓梗死，病变部位越靠近颅侧，90 天结局越差。对于内侧延髓梗死，病变部位越靠背侧，90 天结局越差。
发病时影像学检查对延髓梗死的诊断率并不高，尤其是内侧延髓梗死。对于根据神经体征和症状怀疑延髓梗死的患者，需要重复进行影像学检查。
