Clinical characteristics of bilateral medial medullary infarction in progression

doi:10.3877/cma.j.issn.2095-655X.2023.01.005

Abstract

Abstract:

Objective

To explore the clinical characteristics of progressive bilateral medial medullary infarction(BMMI).

Methods

The clinical data of two patients with progressive BMMI diagnosed in the Department of Neurology, Qingpu Branch of Zhongshan Hospital of Fudan University on December 14, 2021 and May 9, 2022 were chosen to summarize the diagnostic features of BMMI, and the relevant literatures were reviewed.

Results

The patients were all men between the ages of 50 and 40. Case 1 patient′s first symptom was dizziness, while case 2 patient′s first symptom was dizziness with head and neck pain. Both patients experienced lateral limb weakness within 12 hours of onset, which was exacerbated on the second day. As the disease progressed, both patients developed dysarthria and dysphagia. One week after onset, case 1 patient developed quadriplegia. Two patients were diagnosed with BMMI using head magnetic resonance imaging (MRI), which revealed high signal lesions extending along the midline to the dorsal side, resembling a " heart" or " Y" shape on diffusion weighted imaging(DWI).

Conclusions

Quadriplegia, dysphagia, dysarticulation, deep sensory disorders, and other clinical manifestations of BMMI are common. Because the early symptoms of this disease are mostly atypical, it is critical to improve the head MRI examination as soon as possible to facilitate early diagnosis and treatment guidance.

Key words: Bilateral medial medullary infarction, Progressive cerebral infarction, Magnetic resonance imaging, Clinical picture, Drug treatment

Hong Zhou, Weixia Yang. Clinical characteristics of bilateral medial medullary infarction in progression[J]. Chinese Journal of Diagnostics(Electronic Edition), 2023, 11(01): 21-27.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhzdxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-655X.2023.01.005

https://zhzdxdzzz.cma-cmc.com.cn/EN/Y2023/V11/I01/21

Figures/Tables 3

References 25

[1]	Kumral E, Afsar N, Kirbas D，et al.Spectrum of medial medullary infarction: clinical and magnetic resonance imaging findings[J].J Neurol，2002，249(1):85-93.
[2]	Nakajima M, Inoue M, Sakai Y．Contralateral pharyngeal paralysis caused by medial medullary infarction[J].J Neurol Neurosurg Psychiatry，2005，76(9):1292-1293.DOI: 10.1136/jnnp.2004.058586.
[3]	Montalvo M, Ali R, Khan M．Bilateral medial medullary infarction presenting as Guillain Barré Syndrome：a diagnostic challenge[J].J Neurol Sci，2015，352(1-2):135-136.DOI: 10.1016/j.jns.2015.03.048.
[4]	方嵘，吴斌，邓伟平，等．双侧延髓内侧梗死三例并文献复习[J].中国现代神经疾病杂志，2022，22(6):512-518.DOI: 10.3969/j.issn.1672-6731.2022.06.012.
[5]	Zheng R, Zhang T, Zeng X，et al.Unusual neurological manifestations of bilateral medial medullary infarction：a case report[J].Open Med (Wars)，2022，17(1):119-123.DOI: 10.1515/med-2021-0382.
[6]	Gökçal E, Baran G, Niftaliyev E, et al. Risk factors, etiological classification，topographical location，and outcome in medullary infarctions[J].Neurologist，2017，22(4):116-119.DOI: 10.1097/NRL.0000000000000135.
[7]	Hong YH, Zhou LX, Yao M, et al. Lesion topography and its correlation with etiology in medullary infarction：analysis from a multi-center stroke study in China[J].Front Neurol，2018(9):813.DOI: 10.3389/fneur.2018.00813.
[8]	Kim K, Lee HS, Jung YH，et al.Mechanism of medullary infarction based on arterial territory involvement[J].J Clin Neurol，2012，8(2):116-122.DOI: 10.3988/jcn.2012.8.2.116.
[9]	Pongmoragot J, Parthasarathy S, Selchen D，et al.Bilateral medial medullary infarction: a systematic review[J].J Stroke Cerebrovasc Dis，2013，22(6):775-780.DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.010.
[10]	陈士帅，刘训灿，王欣欣，等．典型"心型"影像征的双侧延髓内侧梗死1例报告及文献复习[J].中风与神经疾病杂志，2018，35(2):164-165.
[11]	Zhou ZH, Wu YF, Wu WF，et al.Giant " heart appearance-like sign" on MRI in bilateral ponto-medullary junction infraction: case report[J].BMC Neurol，2020，20(1):107.DOI: 10.1186/s12883-020-01683-7.
[12]	杨信举，赵涌琪．阿加曲班联合阿司匹林序贯治疗对进展性脑卒中的疗效观察[J].药物评价研究，2021，44(10):2130-2133.DOI: 10.7501/j.issn.1674-6376.2021.10.013.
[13]	Lutsep HL, Albers GW, DeCrespigny A, et al. Clinical utility of diffusion-weighted magnetic resonance imaging in the assessment of ischemic stroke[J].Ann Neurol，1997，41(5):574-580.DOI: 10.1002/ana.410410505.
[14]	González RG, Schaefer PW, Buonanno FS，et al.Diffusion-weighted MR imaging: diagnostic accuracy in patients imaged within 6 hours of stroke symptom onset[J].Radiology，1999，210(1):155-162.DOI: 10.1148/radiology.210.1.r99ja02155.
[15]	凌一童，张晓宇，辛华，等．以头晕为首发症状的双侧延髓内侧梗死2例[J].中国卒中杂志，2021，16(12):1268-1272.DOI: 10.3969/j.issn.1673-5765.2021.12.012.
[16]	Lu JP, Wu Y, Xiao F，et al.Bilateral medial medullary infarction with distal stenosis of hypoplastic vertebral artery[J].Chin Med J (Engl)，2019，132(8):998-999.DOI: 10.1097/CM9.0000000000000171.
[17]	梁云云，梁春鹏，王成银，等．以眩晕、呕吐为主症的延髓内侧梗死1例[J].实用临床医学，2017，18(4):42-43.DOI: 10.13764/j.cnki.lcsy.2017.04.016.
[18]	高丹宇，陈晟，赵迎春，等．双侧延髓内侧梗死的临床特征(附1例报道及国内文献分析)[J].卒中与神经疾病，2018，25(1):43-46.DOI: 10.3969/j.issn.1007-0478.2018.01.011.
[19]	吕燕华，曹亦宾，王海英，等．延髓背外侧脑梗死继发Ondine′s curse综合征2例[J].医药前沿，2015，(22):40-40.DOI: 10.3969/j.issn.2095-1752.2015.22.041.
[20]	张秀丽，张美娇，刁剑霞，等．双侧延髓内侧梗死二例临床和影像学分析[J].中华神经科杂志，2013，46(11):748-750.DOI: 10.3760/cma.j.issn.1006-7876.2013.11.007.
[21]	霍晓川，缪中荣．《替罗非班在动脉粥样硬化性脑血管疾病中的临床应用专家共识》解读[J].中国现代神经疾病杂志，2020，20(5):381-385.DOI: 10.3969/j.issn.1672-6731.2020.05.003.
[22]	马胜男，张建红，史海雯，等．进展性脑梗死患者应用阿加曲班后出血的危险因素分析及风险预测模型构建[J].山东医药，2022，62(22):6-10.DOI: 10.3969/j.issn.1002-266X.2022.22.002.
[23]	吴晓君．阿加曲班联合阿司匹林对急性脑梗死早期进展患者的效果观察[J].中国现代药物应用，2022，16(10):103-105.DOI: 10.14164/j.cnki.cn11-5581/r.2022.10.032.
[24]	Di Carlo A, Lamassa M, Baldereschi M, et al. Risk factors and outcome of subtypes of ischemic stroke.Data from a multicenter multinational hospital-based registry.The European Community Stroke Project[J].J Neurol Sci，2006，244(1-2):143-150.DOI: 10.1016/j.jns.2006.01.016.
[25]	刘方彩，曲方，李晓秋，等．延髓内侧梗死45例临床分析[J].解放军医药杂志，2016，28(4):62-66.DOI：10.3969/j.issn.2095-140X.2016.04.015.

Please choose a citation manager

Content to export