Vallis-Solé J, Vila N, Obach V, Alvarez R, González L E, Chamorro A
Department of Medecina, Universitat de Barcelona, Barcelona, Spain.
Muscle Nerve. 1996 Sep;19(9):1093-9. doi: 10.1002/(SICI)1097-4598(199609)19:9<1093::AID-MUS3>3.0.CO;2-V.
In spite of the general clinical uniformity of Wallenberg's syndrome (WS), individual patients present with a slightly different clinical picture, and detailed studies with magnetic resonance imaging (MRI) show differences in the topography of the brain stem lesion. Neurophysiological characterization of the lesion in WS has been known for a long time, but there are no studies on the possible correlation between lesion topography and neurophysiological deficit. Assuming that afferents from the three branches of the trigeminal nerve reach different parts of the trigeminal nuclei, we examined the possible correlation between the lesion topography assessed by the MRI and the neurophysiological deficit, assessed by studying the brain stem reflexes in patients with WS within 2 weeks after stroke. Neurophysiological abnormalities were always located in the afferent branch of the reflexes examined, but not all patients exhibited abnormalities in all responses. The ophthalmic branch was involved in 92.8% of patients, and the mandibular branch in 57.1% of patients. The patients with MRI lesions located in the lower medulla had normal responses with infraorbital or mental nerve stimulation. The results of this neurophysiological study confirm the heterogeneity of WS. Whether the neurophysiological identification of different subgoups of patients is relevant for clinical outcome needs further studies.
尽管延髓背外侧综合征（WS）在临床症状上总体具有一致性，但个体患者的临床表现仍略有不同，而磁共振成像（MRI）的详细研究显示脑干病变的部位存在差异。WS病变的神经生理学特征早已为人所知，但尚无关于病变部位与神经生理功能缺损之间可能存在的相关性的研究。假设三叉神经三个分支的传入纤维到达三叉神经核的不同部位，我们在中风后2周内通过研究WS患者的脑干反射，检查了MRI评估的病变部位与神经生理功能缺损之间的可能相关性。神经生理异常总是位于所检查反射的传入支，但并非所有患者的所有反应都出现异常。92.8%的患者眼支受累，57.1%的患者下颌支受累。MRI显示病变位于延髓下部的患者，眶下神经或颏神经刺激时反应正常。这项神经生理学研究结果证实了WS的异质性。患者不同亚组的神经生理学鉴别是否与临床结局相关，尚需进一步研究。
