Psychiatrist, University of Belgrade, Faculty of Medicine, Laza Lazarević Hospital of Psychiatry, Faculty of Medicine, Belgrade, Serbia.
Associate Researcher of Radiology, University of Belgrade, Faculty of Medicine, Sveti Sava Hospital, Department of CT and MRI, Belgrade, Serbia.
J Stroke Cerebrovasc Dis. 2022 Oct;31(10):106730. doi: 10.1016/j.jstrokecerebrovasdis.2022.106730. Epub 2022 Aug 24.
There is a low incidence of the medullary infarctions and sparse data about the vascular territories, as well as a correlation among the anatomic, magnetic resonance imaging (MRI) and neurologic signs.
Arteries of the 10 right and left sides of the brain stem were injected with India ink, fixed in formalin and microdissected. The enrolled 34 patients with medullary infarctions underwent a neurologic, MRI and Doppler examination.
Four types of the infarctions were distinguished according to the involved vascular territories. The isolated medial medullary infarctions (MMIs) were present in 14.7%. The complete MMIs comprised one bilateral infarction (2.9%), whilst the incomplete and partial MMIs were observed in 5.9% and 8.9%, respectively. The anterolateral infarctions (ALMIs) were very rare (2.9%). The complete and incomplete lateral infarctions (LMIs), noted in 35.3%, comprised 11.8% and 23.6%, respectively, that is, the anterior (5.9%), posterior (8.9%), deep (2.9%), and peripheral (5.9%). Dorsal ischemic lesions (DMIs) occurred in 11.8%, either as a complete (2.9%), or isolated lateral (5.9%) or medial infarctions (2.9%). The remaining ischemic regions belonged to various combined infarctions of the MMI, ALMI, LMI and DMI (35.3%). The infarctions most often affected the upper medulla (47.1%), middle (11.8%), or both (29.5%). Several motor and sensory signs were manifested following infarctions, including vestibular, cerebellar, ocular, sympathetic, respiratory and auditory symptoms.
There was a good correlation among the vascular territories, MRI ischemia features, and neurologic findings regarding the medullary infarctions.
延髓梗死发病率低，有关血管分布区域的资料也很少，解剖、磁共振成像（MRI）和神经体征之间存在相关性。
对 10 例右侧和左侧脑桥动脉进行了印度墨水注射、福尔马林固定和显微解剖。34 例延髓梗死患者进行了神经学、MRI 和多普勒检查。
根据涉及的血管分布区域，区分了四种类型的梗死。孤立的内侧延髓梗死（MMI）占 14.7%。完全 MMI 包括双侧梗死（2.9%），而不完全和部分 MMI 分别为 5.9%和 8.9%。前外侧梗死（ALMI）非常罕见（2.9%）。完全和不完全外侧梗死（LMIs）分别占 35.3%，包括 11.8%和 23.6%，即前（5.9%）、后（8.9%）、深（2.9%）和外周（5.9%）。背侧缺血性病变（DMIs）占 11.8%，包括完全性（2.9%）、孤立性外侧（5.9%）或内侧梗死（2.9%）。其余的缺血区域属于 MMI、ALMI、LMI 和 DMI 的各种联合梗死（35.3%）。梗死最常影响上延髓（47.1%）、中延髓（11.8%）或两者（29.5%）。延髓梗死后常出现前庭、小脑、眼部、交感神经、呼吸和听觉症状等多种运动和感觉体征。
延髓梗死的血管分布区域、MRI 缺血特征和神经学表现之间存在良好的相关性。
