Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA.
NYU Grossman School of Medicine, New York, NY, USA.
Acta Neurol Scand. 2021 Sep;144(3):283-287. doi: 10.1111/ane.13445. Epub 2021 May 3.
Infarction of the medulla has been associated with prolongation of the QTc, severe arrhythmia, and sudden cardiac death, yet the precise anatomical substrate remains uncertain.
We sought to determine the possible anatomical structures relating to QTc-prolongation in patients with acute medullary infarction.
We included 12 subjects with acute ischemic medullary infarction on brain MRI, who presented within 4.5 h from the last known well time, with a 90-day follow-up. For an unbiased lesion analysis, medullary infarcts were manually outlined on diffusion weighted MRI and co-registered with an anatomical atlas.
Nine out of 12 had QTc-prolongation. Qualitative and semi-quantitative comparisons were made between infarct location and QTc-prolongation. Among patients with QTc-prolongation, the greatest degree of congruence of the infarct location was over the dorsal vagal nucleus (DVN, 8 out of 9). There was a significant correlation between the number of sections showing infarction of the DVN and presence of QTc-prolongation (r = .582, p = .047). Among patients without QTc-prolongation, the maximum lesion overlap included the medial aspect of the gigantocelluar reticular nucleus of the reticular formation.
We found that the DVN is a key anatomical substrate related to QTc-prolongation. Further studies with more patients and high-resolution, volumetric MRI are needed to confirm our findings.
延髓梗死与 QTc 延长、严重心律失常和心源性猝死有关，但确切的解剖学基础仍不确定。
我们旨在确定与急性延髓梗死患者 QTc 延长相关的可能解剖结构。
我们纳入了 12 例急性缺血性脑 MRI 显示的延髓梗死患者，这些患者在最后一次已知发病时间后 4.5 小时内出现症状，随访 90 天。为了进行无偏的病变分析，手动在弥散加权 MRI 上勾画延髓梗死，并与解剖图谱配准。
12 例中有 9 例出现 QTc 延长。对梗死部位与 QTc 延长进行了定性和半定量比较。在 QTc 延长的患者中，梗死部位与延髓迷走神经背核（DVN）的最大程度一致（9 例中有 8 例）。显示 DVN 梗死的节段数与 QTc 延长的存在之间存在显著相关性（r =.582，p =.047）。在无 QTc 延长的患者中，最大的病变重叠包括网状结构的巨细胞网状核的内侧部分。
我们发现延髓迷走神经背核是与 QTc 延长相关的关键解剖学基础。需要进一步对更多患者进行研究，采用高分辨率、容积 MRI 来证实我们的发现。
