MR Assessment of Lateral Medullary Syndrome

側延腦症候群是因為缺血性病灶發生於側延腦所產生的各種症狀綜合症，大部分是由於脊椎動脈或部分後下小腦動脈狹窄、阻塞所引起。臨床症狀因各種不同相關的神經核和徑路侵犯而異，除了磁振造影外，其它各種影像攝影包括電腦斷層檢查均不易診斷出來。本文收集35例側延腦梗塞病人，由磁振影像找出其病灶並依其分佈之位置、大小分成四種型態，病灶較接近腹位為腹位型，背部表層型則近延腦表淺後部，大型病灶代表直徑超過10mm或橫越側部範圍者，典型病灶則是座落於腹位型與背部表層型之間，病灶直徑小於或等於10mm者。分析其臨床表徵之異同，並加以討論。其中腹位型與背部表層型在重要的臨床表徵上有較明顯的差異，前者因侵犯脊髓視丘徑路，下行自主神經纖維和第九、十神經核而有對側身體感覺遲鈍，Horner's症候群和吞嚥困難等，為背部表層型所缺。而較大型的梗塞其位置涵蓋基本型之各神經核和徑路，因此臨床表徵分佈大致上無差別。我們期望磁振造影可以帶給臨床醫師在診察側延腦症候群病人有助益。

關鍵字

側延腦症候群； Wallenberg's症候群；磁振造影；腦幹中風

並列摘要

To correlate clinical manifestations of lateral medullary syndrome with the location of ischemic infarcts presenting on magnetic resonance imaging (MRI), 35 patients were studied and categorized into four types. They were ventral type, dorsosuperficial type, large type (diameter＞10 mm) and typical type (located between ventral and dorsosuperficial type, diameter≤10 mm). All of these patients had only single bright signal lesion in the lateral medulla on T2-weighted images. The most frequent symptom was gait disturbance (77%). Limb ataxia was the commonest sign in neurologic examination, presenting in 86% of all patients. Significant difference of clinical presentations were found in ventral (9 cases) and dorsosuperficial type (5 cases). The ventral type lesions involved spinothalamic tracts, descending sympathetic fibers and ambiguus nuclei. They had clinical deficits of contralateral body hypalgesia, Homer's syndrome and palatal weakness respectively, and were not presented in patients with dorsosuperficial lesions. The location of large type and the typical type lesions were somewhat overlapped. Clinical manifestations of both types were evenly distributed and no significant difference. MR angiography were obtained in 30 patients. Variable combination of stenosis or occlusion of bilateral vertebral arteries and basilar artery were found in 22 patients (73%). MR imaging is excellent for defining location of ischemic infarcts in the medulla. MR angiography will help clinician for setting up proper management.

並列關鍵字

Lateral medullary syndrome ； Wallenberg's syndrome ； Magnetic resonance imaging ； Brain stem stroke

國際替代計量

MR Assessment of Lateral Medullary Syndrome

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