Department of Neurology, Municipal Hospital Affiliated to the Medical School of Taizhou University, Taizhou, China.
Department of Neurosurgery, Municipal Hospital Affiliated to the Medical School of Taizhou University, Taizhou, China.
Ann Palliat Med. 2022 Oct;11(10):3330-3336. doi: 10.21037/apm-22-1098.
Lateral medullary syndrome is the most common type of brainstem infarction. Lateral medullary syndrome results in damage to the corresponding cranial nerve nuclei and the nucleus tractus solitarius, with vertigo, ipsilateral ataxia, crossed sensory disturbances, Horner's sign, bulbar palsy, and other underlying symptoms or signs. However, cases with cardiac arrhythmia and other autonomic dysfunctions as the primary manifestations are less common. Clinically, sudden death occasionally occurs in patients with lateral medullary syndrome, which may be associated with severe cardiac arrhythmia. These patients may suffer in life-threatening arrhythmia and even cardiac arrest, and vital signs should be closely monitored to prevent sudden death. In younger patients, vertebral artery dissection is the most common cause.
Here, we present a case of lateral medullary syndrome caused by vertebral artery dissection with severe bradycardia. The patient was a 49-year-old man who was admitted with "sudden onset of numbness in the left limbs and right side of the face for 1 hour". Electrocardiogram (ECG) monitoring showed a repeated heart rate decrease to as low as 23 beats/min, followed by a gradual increase in heart rate to 35-55 beats/min after 2-3 seconds. Head magnetic resonance imaging (MRI) examination revealed right dorsolateral cerebral infarction of the medulla oblongata. Digital subtraction angiography (DSA) revealed a right vertebral artery dissecting aneurysm. We performed an emergency placement of a temporary pacemaker, followed by conservative treatment with platelet aggregation inhibitors, vascular softening agents and improved collateral circulation. Elective spring coil embolization of the vertebral artery dissecting aneurysm and stent implantation were performed. At outpatient follow-up, the patient had a good prognosis.
Clinical management of patients with lateral medullary syndrome should be prioritized, with close cardiac monitoring at the early stages of observation and pacemaker placement and tracheal intubation as required to prevent adverse events.
外侧延髓综合征是最常见的脑干梗死类型。外侧延髓综合征导致相应的颅神经核和孤束核受损，伴有眩晕、同侧共济失调、交叉感觉障碍、Horner 征、球麻痹等基础症状或体征。然而，以心律失常等自主神经功能障碍为主要表现的病例较少见。临床上，外侧延髓综合征患者偶尔会发生猝死，可能与严重心律失常有关。这些患者可能会遭受危及生命的心律失常甚至心脏骤停，应密切监测生命体征，以防止猝死。在年轻患者中，椎动脉夹层是最常见的原因。
本研究报告了一例由椎动脉夹层引起的外侧延髓综合征伴严重心动过缓的病例。患者为 49 岁男性，因“左侧肢体麻木和右侧面部麻木 1 小时”入院。心电图（ECG）监测显示心率反复下降至低至 23 次/分，随后在 2-3 秒后逐渐增加至 35-55 次/分。头部磁共振成像（MRI）检查显示右侧延髓背外侧脑梗死。数字减影血管造影（DSA）显示右侧椎动脉夹层动脉瘤。我们进行了紧急临时起搏器放置，随后进行血小板聚集抑制剂、血管软化剂和改善侧支循环的保守治疗。选择性弹簧圈栓塞椎动脉夹层动脉瘤和支架植入。门诊随访时，患者预后良好。
外侧延髓综合征患者的临床管理应优先考虑，在观察早期密切进行心脏监测，并根据需要进行起搏器放置和气管插管，以防止不良事件发生。
