Kang Hyun Goo, Kim Bum Joon, Lee Sang Hun, Kang Dong-Wha, Kwon Sun U, Kim Jong S
Department of Neurology, Chosun University Hospital, Gwang-ju, Republic of Korea.
Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Cerebrovasc Dis. 2018;45(3-4):132-140. doi: 10.1159/000487672. Epub 2018 Mar 20.
Lateral medullary infarction (LMI) is not an uncommon disease. Although lesions are usually restricted to the lateral medullary area, some patients have additional infarcts in other parts of the brain. The clinical features and prognosis of isolated LMI (pure LMI, LMIpr) have been investigated. However, it remains unclear whether clinical characteristics, prognosis and factors associated with prognosis differ between patients with LMIpr and those with additional lesions (LMI plus, LMIpl).
Patients with LMI identified by MRI were enrolled. The demographic and clinical characteristics, in-hospital outcome (intensive care unit [ICU] admission, pneumonia and modified Rankin scale [mRS] at discharge), and long-term residual symptoms (vertigo/dizziness, sensory disturbances, dysphagia) and outcomes (occurrence of stroke, acute coronary syndrome [ACS], death, and mRS at follow-up) were compared between LMIpr and LMIpl patients. Factors associated with poor functional outcome (mRS 2-6) at the follow-up were analyzed.
Among 248 LMI patients, 161 (64.9%) had LMIpr and 87 (35.1%) had LMIpl. During admission, patients with LMIpl more frequently experienced ICU care, pneumonia and had a higher discharge mRS (3 vs. 2; p < 0.001) than LMIpr patients. The occurrence of stroke, ACS, frequency of death and functional outcome was not different during follow-up. However, residual neurologic symptoms such as dizziness (p = 0.002), dysphagia (p = 0.04) and sensory symptoms (p < 0.001) were more frequent in LMIpr than in LMIpl patients. In LMIpr patients, the rostral location of LMI was associated with poor functional outcome (p = 0.041), whereas in LMIpl patients, the presence of medial posterior-inferior cerebellar artery lesion was associated with good functional outcome (p = 0.030).
Although the short-term outcome is poorer in LMIpl than LMIpr patients, long-term residual symptoms are more common in LMIpr patients. The location of the LMI and extra-medullary lesion affects the long-term functional outcome of LMIpr and LMIpl patients respectively.
延髓外侧梗死（LMI）并非罕见疾病。尽管病灶通常局限于延髓外侧区域，但部分患者脑部其他部位还存在梗死灶。孤立性LMI（单纯LMI，LMIpr）的临床特征及预后已得到研究。然而，LMIpr患者与合并其他病灶的患者（LMI合并，LMIpl）在临床特征、预后及预后相关因素方面是否存在差异仍不明确。
纳入经MRI确诊为LMI的患者。比较LMIpr和LMIpl患者的人口统计学和临床特征、住院结局（入住重症监护病房[ICU]、肺炎及出院时改良Rankin量表[mRS]评分）、长期残留症状（眩晕/头晕、感觉障碍、吞咽困难）及结局（卒中发生、急性冠状动脉综合征[ACS]、死亡及随访时mRS评分）。分析随访时与功能结局不良（mRS 2 - 6）相关的因素。
248例LMI患者中，161例（64.9%）为LMIpr，87例（35.1%）为LMIpl。住院期间，LMIpl患者比LMIpr患者更频繁地接受ICU护理、发生肺炎，且出院时mRS评分更高（3分对2分；p < 0.001）。随访期间，卒中、ACS的发生率、死亡频率及功能结局无差异。然而，LMIpr患者残留神经症状如头晕（p = 0.002）、吞咽困难（p = 0.04）及感觉症状（p < 0.001）比LMIpl患者更常见。在LMIpr患者中，LMI的头端位置与功能结局不良相关（p = 0.041），而在LMIpl患者中，小脑后下内侧动脉病变的存在与功能结局良好相关（p = 0.030）。
尽管LMIpl患者的短期结局比LMIpr患者差，但LMIpr患者长期残留症状更常见。LMI及髓外病变的位置分别影响LMIpr和LMIpl患者的长期功能结局。
