Kobayashi Saro, Suzuki Keisuke, Takekawa Hidehiro, Watanabe Yuji, Okamura Madoka, Suzuki Ayano, Tsukui Daisuke, Hirata Koichi
Department of Neurology, Dokkyo Medical University.
Brain Nerve. 2020 Aug;72(8):901-905. doi: 10.11477/mf.1416201617.
A 70-year-old man presented with dizziness and unsteadiness when standing and was hospitalized in another hospital. Magnetic resonance imaging (MRI) of the brain on Day 1 showed no abnormalities. The patient developed respiratory failure on Day 1and flaccid tetraplegia on Day 3, and was transferred to our hospital. Progressive upper and lower limb weakness and bulbar symptoms suggested Guillain-Barré syndrome or its variant. Diffusion-weighted MRI on Day 6 disclosed high signal intensities in the bilateral medial portion of the medulla, and the patient was diagnosed with bilateral medial medulla infarction. Bilateral medial medulla infarction should be considered when a patient shows progressive tetraplegia, and bulbar palsy and follow-up MRI is important to confirm the diagnosis. (Received January 23, 2020; Accepted April 21, 2020; Published August 1, 2020).
一名70岁男性因站立时头晕和不稳在另一家医院住院。第1天的脑部磁共振成像(MRI)显示无异常。患者在第1天出现呼吸衰竭,第3天出现弛缓性四肢瘫,随后被转至我院。进行性的上肢和下肢无力以及延髓症状提示吉兰-巴雷综合征或其变异型。第6天的扩散加权MRI显示延髓双侧内侧部分有高信号强度,患者被诊断为双侧内侧延髓梗死。当患者出现进行性四肢瘫和延髓麻痹时,应考虑双侧内侧延髓梗死,后续的MRI检查对于确诊很重要。(2020年1月23日收稿;2020年4月21日接受;2020年8月1日发表)