Yagi Ryuichiro, Nishimoto Yoshinori, Yamada Satoshi, Nakashima Hanae, Okada Kensuke, Konoeda Fumie, Hoshino Haruhiko
Department of Neurology, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
J Stroke Cerebrovasc Dis. 2019 Jan;28(1):229-231. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.027. Epub 2018 Oct 15.
Medullary hemorrhage is quite rare among brain stem hemorrhage cases, thus the clinical course remains unclear. In the medulla oblongata, respiratory centers are located and previous reports indicate that medullary lesions have possible relationship with acute respiratory distress syndrome. This kind of respiratory failure is commonly caused by neurogenic pulmonary edema (NPE), which is defined as noncardiac noninfectious acute respiratory distress syndrome with changes in intracranial condition including cerebrovascular events. However, to date, very few reports have described cases with medullary hemorrhage accompanied by NPE. We experienced 2 patients with medullary hemorrhages. A 65-year-old man presented with sudden onset of headache, whose head computed tomography showed right medullary hemorrhage. Another 76-year-old woman was transferred because of sudden limb weakness and diagnosed with left medullary hemorrhage. Digital subtraction angiography showed the presence of arteriovenous fistula in the medulla oblongata and drainer veins in the second case. Both cases were complicated by acute pulmonary edema in the early phase, suggesting the possible association of the medullary hemorrhage with NPE.
延髓出血在脑干出血病例中相当罕见，因此其临床病程仍不清楚。在延髓中存在呼吸中枢，既往报道表明延髓病变与急性呼吸窘迫综合征可能存在关联。这种呼吸衰竭通常由神经源性肺水肿（NPE）引起，神经源性肺水肿被定义为伴有颅内状况改变（包括脑血管事件）的非心源性非感染性急性呼吸窘迫综合征。然而，迄今为止，很少有报告描述延髓出血伴有NPE的病例。我们诊治了2例延髓出血患者。一名65岁男性突发头痛，头部计算机断层扫描显示右侧延髓出血。另一名76岁女性因突发肢体无力而转诊，被诊断为左侧延髓出血。数字减影血管造影显示第二例患者延髓存在动静脉瘘和引流静脉。两例患者均在早期并发急性肺水肿，提示延髓出血与NPE可能存在关联。
