Woischneck D, Kapapa T, Grimm C, Skalej M, Schmitz B, Blumstein N, Firsching R
Neurochirurgie, Klinikum Landshut.
Z Orthop Unfall. 2011 Oct;149(5):541-5. doi: 10.1055/s-0031-1280170. Epub 2011 Oct 7.
Cranial magnetic resonance imaging (MRI) was performed in 250 patients who had been unconscious post-trauma for at least 24 hours. The frequency and the characteristics of injuries to the upper cervical myelon were determined.
Between 1996 and 2009, MRI was carried out within 8 days of trauma.
No lesions of the upper cervical medulla were found without accompanying damage to the medulla oblongata. Two groups were found to have a lesion in the upper cervical myelon. (i) In 3.2 % of the patients in a state of deep coma MRI revealed lesions in the entire brain stem. These died without waking from coma. (ii) 2 % of the patients were found to have additional damage to the distal medulla oblongata. These victims of high-speed traumas awoke from coma after 2-3 days. They revealed frontal contusions of the brain and traumatic subarachnoidal hemorrhages. Injuries to the bony upper cervical spine and/or the skull base were frequent. Four of them died, one patient survived with severe disabilities.
Two types of lesions involving the upper cervical myelon could be differentiated, both of which occur only in association with lesions in the medulla oblongata.
对250例创伤后昏迷至少24小时的患者进行了头颅磁共振成像（MRI）检查，以确定上颈髓损伤的频率和特征。
1996年至2009年期间，在创伤后8天内进行了MRI检查。
未发现上颈髓无延髓伴随损伤的病变。发现两组患者存在上颈髓病变。（i）3.2%处于深昏迷状态的患者MRI显示整个脑干有病变。这些患者未苏醒即死亡。（ii）2%的患者被发现延髓远端有额外损伤。这些高速创伤的受害者在2 - 3天后从昏迷中苏醒。他们表现为额叶脑挫伤和创伤性蛛网膜下腔出血。上颈椎和/或颅底骨折很常见。其中4例死亡，1例患者存活但有严重残疾。
可以区分两种累及上颈髓的病变类型，这两种病变均仅与延髓病变相关。
