Division of Neurology, University Medical Center Rizk Hospital, Beirut, Lebanon.
J Neurol Sci. 2013 Sep 15;332(1-2):154-5. doi: 10.1016/j.jns.2013.06.028. Epub 2013 Jul 9.
Medullary infarcts are occasionally associated with facial palsy of the central type (C-FP). This finding can be explained by the course of the facial corticobulbar (F-CB) fibers. It is believed that fibers that project to the upper facial muscles decussate at the level of the facial nucleus, whereas those destined to the lower facial muscles decussate more caudally, at the level of the mid or upper medulla. It has been proposed that the lower F-CB fibers descend ventromedially near the corticospinal tract to the upper medulla where they cross midline and ascend dorsolaterally. Accordingly, ventromedial medullary infarcts are expected to result in contralateral facial and limb weakness. We report a patient with a medial medullary infarct restricted to the right pyramid and associated with ipsilateral C-FP and contralateral hemiparesis. The neurological findings are discussed in light of the hypothetical course of the F-CB fibers in the medulla.
延髓梗死偶尔与中枢性面瘫（C-FP）有关。这种发现可以通过面部皮质核束（F-CB）纤维的走行来解释。据信，支配上部面肌的纤维在面核水平交叉，而支配下部面肌的纤维在更靠尾侧的中脑或延髓水平交叉。有人提出，下部 F-CB 纤维在靠近皮质脊髓束的腹侧下降至延髓，在那里它们中线交叉并背外侧上升。因此，预计腹侧延髓梗死将导致对侧面肌和肢体无力。我们报告了一例局限于右侧锥体的内侧延髓梗死患者，伴有同侧 C-FP 和对侧偏瘫。根据 F-CB 纤维在延髓中的假设走行，讨论了神经学发现。
