Nishihira Takahito, Suzuki Keisuke, Takekawa Hidehiro, Nakamura Toshiki, Iwasaki Akio, Hirata Koichi
Department of Neurology, Dokkyo Medical University.
Rinsho Shinkeigaku. 2014;54(10):819-23. doi: 10.5692/clinicalneurol.54.819.
A 45-year-old man noted a tendency to fall to the left side on standing following headache and vomiting. Neurological findings were unremarkable except for truncal lateropulsion to the left side. Brain magnetic resonance imaging (MRI) showed a small infarct in the left inferolateral part of medulla. Clinical and imaging findings suggested vertebral artery dissection as the cause of stroke. On hospital day 6, the patient developed decreased pain and temperature sensation in the right side below T10 sensory level and decreased sweating on the left side of the face with miosis of the left pupil. Brain MRI revealed an expanded lesion of the left inferolateral part of medulla. In our patient, the involvement of the spinocerebellar tract and the lateral spinothalamic tract likely contributed to the development of truncal lateropulsion and sensory disturbance below thoracic levels, respectively. Our case is clinically important in understanding a correlation between clinical symptoms and lateral medullary lesions.
一名45岁男性在头痛和呕吐后站立时出现向左倾倒的倾向。神经系统检查结果无明显异常，仅见躯干向左偏斜。脑部磁共振成像（MRI）显示延髓左后外侧部有一个小梗死灶。临床和影像学表现提示椎动脉夹层是卒中的病因。住院第6天，患者T10感觉平面以下右侧疼痛和温度觉减退，左侧面部出汗减少伴左侧瞳孔缩小。脑部MRI显示延髓左后外侧部病变扩大。在我们的患者中，脊髓小脑束和脊髓丘脑侧束受累可能分别导致了躯干偏斜和胸段以下感觉障碍的发生。我们的病例对于理解临床症状与延髓外侧病变之间的相关性具有重要临床意义。
