Wang Yanqiang, Zhang Lei, Zhang Bingjun, Dai Yongqiang, Kang Zhuang, Lu Ciyong, Qiu Wei, Hu Xueqiang, Lu Zhengqi
Department of Neurology, Multiple Sclerosis Center, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou, 510630, Guangdong, China,
J Neurol. 2014 May;261(5):954-62. doi: 10.1007/s00415-014-7298-7. Epub 2014 Mar 9.
Brainstem involvement, especially the medulla oblongata (MO), has been reported in neuromyelitis optica spectrum disorders (NMOSDs). The purpose of this study was to investigate retrospectively and compare clinical, laboratory, and imaging features of NMOSDs with and without MO lesions. A total of 170 patients with NMOSDs were enrolled, including 44 patients with MO lesions and 126 patients without MO lesions. Clinical features, laboratory tests, and magnetic resonance imaging findings among these patients were assessed. MO lesions were found in 25.9 % of the NMOSDs patients. The mean duration was 13 months. Patients with MO lesions had a higher Annualized relapse rate and Expanded Disability Status Score Scale. Headache, dizziness, nystagmus, dysarthria, intractable hiccup and nausea, choking cough or dysphagia, movement disorders, and neuropathic pain were more common in MO lesion patients. Patients with MO lesions were more frequently complicated with thyroid diseases. Multiple brain involvement, More importantly, Longitudinally extensive transverse myelitis were more frequently found in patients with MO lesions. MO lesions might be a symbol of more severe neurologic deficits and worse prognosis of NMOSDs.
在视神经脊髓炎谱系障碍（NMOSD）中，已报道存在脑干受累情况，尤其是延髓（MO）。本研究的目的是回顾性调查并比较有和没有MO病变的NMOSD患者的临床、实验室和影像学特征。共纳入170例NMOSD患者，其中44例有MO病变，126例无MO病变。对这些患者的临床特征、实验室检查和磁共振成像结果进行了评估。在25.9%的NMOSD患者中发现了MO病变。平均病程为13个月。有MO病变的患者年化复发率和扩展残疾状态评分量表得分更高。头痛、头晕、眼球震颤、构音障碍、顽固性呃逆和恶心、呛咳或吞咽困难、运动障碍和神经性疼痛在有MO病变的患者中更常见。有MO病变的患者更常并发甲状腺疾病。更重要的是，有MO病变的患者更常出现多脑受累和纵向广泛横贯性脊髓炎。MO病变可能是NMOSD患者神经功能缺损更严重、预后更差的一个标志。
