Departments of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Eur J Neurol. 2012 Nov;19(11):1433-9. doi: 10.1111/j.1468-1331.2012.03722.x. Epub 2012 Apr 24.
Few studies have focused on the mechanisms underlying medullary infarctions. Our aim in this study was to investigate stroke mechanisms in patients with medullary infarctions and to determine the clinical, radiological and laboratory characteristics of these patients with different underlying stroke etiologies.
Consecutive patients with medullary infarction were analysed. Stroke mechanisms were classified as large artery disease (LAD), cardiogenic embolism (CE), small vessel disease (SVD), arterial dissection or undetermined etiology. Clinical, radiological and laboratory factors were analysed according to the location of the lesion and stroke mechanisms.
A total of 77 patients were enrolled in this study. Amongst them, 53 (68.8%) patients had lateral medullary infarction (LMI), 22 (28.6%) had medial medullary infarction (MMI), and the remaining 2 (2.6%) had hemimedullary infarction. In both LMI and MMI patients, LAD was the most frequently encountered stroke mechanism. Arterial dissection was the second most common cause followed by SVD and CE in patients with LMI, whereas SVD was more frequently observed (P < 0.001) and dissection and CE were less prevalent (P < 0.001 and P = 0.024, respectively) in MMI than in LMI. Regarding differences amongst stroke etiologies, patients with dissection were younger and had a significantly lower incidence of metabolic syndrome (P = 0.002 and P = 0.009, respectively) than patients with LAD and SVD. Patients in the LAD (19/34, 60%) and dissection groups (12/14, 75%) had abnormal perfusion-weighted MRI (PWI) findings, whereas all patients with SVD (9/9) had normal PWI findings (P < 0.001).
Stroke mechanisms in medullary infarction differ between LMI and MMI. Clinical and radiological characteristics, especially PWI features, are helpful in discriminating the etiologies of stroke in these patients.
很少有研究关注延髓梗死的发病机制。本研究旨在探讨延髓梗死患者的卒中机制，并确定不同病因下这些患者的临床、影像学和实验室特征。
连续分析了患有延髓梗死的患者。卒中机制分为大动脉疾病（LAD）、心源性栓塞（CE）、小血管疾病（SVD）、动脉夹层或病因不明。根据病变位置和卒中机制分析临床、影像学和实验室因素。
共纳入 77 例患者。其中，53 例（68.8%）患者为外侧延髓梗死（LMI），22 例（28.6%）为内侧延髓梗死（MMI），其余 2 例（2.6%）为半侧延髓梗死。在 LMI 和 MMI 患者中，LAD 是最常见的卒中机制。动脉夹层是第二常见的原因，其次是 SVD 和 CE 在 LMI 患者中，而 SVD 更为常见（P<0.001），夹层和 CE 较少见（P<0.001 和 P=0.024）。关于卒中病因的差异，夹层患者较年轻，且代谢综合征发生率明显较低（P=0.002 和 P=0.009）。LAD（19/34，60%）和夹层组（12/14，75%）患者的灌注加权磁共振成像（PWI）异常，而所有 SVD 患者（9/9）的 PWI 正常（P<0.001）。
延髓梗死的卒中机制在 LMI 和 MMI 之间有所不同。临床和影像学特征，特别是 PWI 特征，有助于鉴别这些患者的卒中病因。
