von Heinemann Philipp, Grauer Oliver, Schuierer Gerhard, Ritzka Markus, Bogdahn Ulrich, Kaiser Bernhard, Schlachetzki Felix
University of Regensburg, Neurology, Universitaetsstr.84, Regensburg, 93053, Germany.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.02.2009.1625. Epub 2009 Oct 12.
Cardiac arrest is a rare complication in Wallenberg syndrome, despite the fact that the brainstem, especially the lower medulla, modulates sympathetic and parasympathetic activity. In the case reported here, a 45-year-old man was admitted with clinical symptoms of Wallenberg syndrome, including right sided hemiparesis secondary to dissection of the right vertebral artery. During the following days he experienced several spells of self limiting cardiac arrests, which made the implantation of a pacemaker necessary. Magnetic resonance imaging scan showed an infarction on the lower right and dorsolateral medulla. This might have affected the central sympathetic neurons which normally inhibit the nucleus of the solitary tract. The disinhibition of the nucleus tractus solitarii may have led to an increase of parasympathetic outflow resulting in bradycardia/asystolia. This case report describes a rare indication for transient or permanent therapy with a cardiac pacemaker in Wallenberg syndrome.
心脏骤停是延髓背外侧综合征（Wallenberg syndrome）中的一种罕见并发症，尽管脑干尤其是延髓下部调节交感神经和副交感神经活动。在本文报道的病例中，一名45岁男性因出现延髓背外侧综合征的临床症状入院，包括继发于右椎动脉夹层的右侧偏瘫。在随后的几天里，他经历了几次可自行缓解的心脏骤停发作，这使得有必要植入起搏器。磁共振成像扫描显示右延髓下部和背外侧梗死。这可能影响了通常抑制孤束核的中枢交感神经元。孤束核的去抑制可能导致副交感神经输出增加，从而引起心动过缓/心搏停止。本病例报告描述了延髓背外侧综合征中使用心脏起搏器进行临时或永久治疗的罕见指征。
