Ikeda K, Kinoshita M, Iwasaki Y, Wakata N
Fourth Department of Internal Medicine, Toho University Ohashi Hospital, Tokyo, Japan.
No To Shinkei. 1998 Oct;50(10):949-52.
We report a 40-year-old man with hypertension and diabetes mellitus, who had crossed oral-pedal sensory disturbance in lateral medullary infarction. He suddenly developed dysesthesia in the right mount and the left leg. His blood pressure was 150/90 mmHg. Neurological examination showed Horner's sign in the right eye and horizontal nystagmus. Sensory function revealed decreased temperature, hypalgesia and dysesthesia in the right mouth and the left leg. Vibratory and position sense were normal. T1- and T2-weighted images disclosed a low and high signal intensity area in the lateral portion of the right medulla oblongata, respectively. Brain and neck MRA using time-of-flight sequence revealed no obvious abnormal structures. We have diagnosed him as lateral medullary infarction. The unique topography of sensory dysfunction thought to be attributed to a far-lateral lesion in the medulla oblongata. Our patient suggests that lateral medullary infarction causes variable patterns of sensory disturbance. Thus, lateral medullary infarction should be warranted when we encounter patients with miscellaneous distribution of sensory impairment, such as crossed mouth-foot hypalgesia.
我们报告一名40岁患有高血压和糖尿病的男性，其在延髓外侧梗死时出现了交叉性口-足感觉障碍。他突然出现右口部和左腿感觉异常。他的血压为150/90 mmHg。神经系统检查显示右眼有霍纳氏征和水平眼震。感觉功能显示右口部和左腿温度觉减退、痛觉减退和感觉异常。振动觉和位置觉正常。T1加权和T2加权图像分别显示右延髓外侧部有低信号和高信号区。使用时间飞跃序列的脑部和颈部MRA未发现明显异常结构。我们将他诊断为延髓外侧梗死。感觉功能障碍的独特分布被认为归因于延髓远外侧病变。我们的患者表明延髓外侧梗死可导致多种感觉障碍模式。因此，当我们遇到感觉障碍分布多样的患者，如交叉性口-足痛觉减退时，应考虑延髓外侧梗死。
