摘要：

目的 总结延髓背外侧综合征的临床特征。方法 回顾分析 2015 年 3 月至 2017 年 10 月共 36 例延髓背外侧综合征患者的临床表现、影像学特点、病因和诱发因素、治疗和预后。结果 36 例患者临床主要表现为头晕、呕吐 23 例（63.89%），饮水呛咳、吞咽困难 21 例（58.33％），构音障碍 19 例（52.78％），感觉障碍 17 例（47.22％），眼震 15 例（41.67％），共济失调 11 例（30.56％），Horner 征阳性 8 例（22.22％），呃逆 7 例（19.44％），面神经麻痹 6 例（16.67％），偏瘫 5 例（13.89％），意识障碍 5 例（13.89%），复视 2 例（5.56％）；12 例（33.33％）符合典型延髓背外侧综合征；MRI 均可见延髓背外侧梗死灶，其中上延髓型为 10 例（27.78%），中延髓型 9 例（25%），下延髓型 17 例（47.22%）；CTA 可见 5 例（5/10）椎动脉狭窄，3 例（3/10）小脑后下动脉狭窄；椎动脉 B 超可见 11 例（11/15）椎动脉细小或狭窄；经颅多普勒超声可见 5 例（5/9）椎动脉和基底动脉血流速度减慢，峰值后移；数字减影血管造影术可见 9 例（9/13）椎动脉狭窄，2 例（2/13）小脑后下动脉狭窄。6 例（16.67%）予静脉溶栓，30 例（83.33%）予内科综合治疗；34 例（94.44%）明显好转，2 例（5.56%）因循环衰竭而死亡。结论 延髓背外侧综合征临床表现多样，仅部分患者有典型临床表现，明确诊断需结合影像学检查，临床预后与梗死灶部位、面积和并发症等有关。

关键词: 延髓外侧综合征, 小脑后下动脉（非 MeSH 词）, 椎动脉, 磁共振成像

Abstract:

Objective To summarize the clinical features of Wallenberg syndrome (WS). Methods  Clinical manifestations, imaging features, etiology and predisposing factors, treatment and prognosis of 36 WS patients from March 2015 to October 2017 were retrospectively analyzed. Results Clinical manifestations of 36 patients included dizziness and vomiting in 23 cases (63.89%), bucking when drinking water and dysphagia in 21 cases (58.33%), dysarthria in 19 cases (52.78%), sensory disturbance in 17 patients (47.22%), nystagmus in 15 cases (41.67%), ataxia in 11 cases (30.56%), positive Horner signs in 8 cases (22.22%), hiccups in 7 cases (19.44%), facial nerve paralysis in 6 cases (16.67%), hemiplegia in 5 cases (13.89% ), conscious disturbance in 5 patients (13.89% ), and double vision in 2 cases (5.56% ). Twelve patients (33.33% ) had typical dorsolateral medullary syndrome. MRI revealed medulla oblongata dorsolateral infarcts, which were located in upper medulla oblongata in 10 cases (27.78%), medial medulla oblongata in 9 cases (25%) and lower medulla oblongata in 17 cases (47.22%). CTA of 10 cases showed vertebral artery (VA) stenosis in 5 patients (5/10), and posterior inferior cerebellar artery (PICA) stenosis in 3 cases (3/10). VA ultrasound of 15 cases showed narrowing or stenosis in 11 cases (11/15). Transcranial Doppler ultrasonography (TCD) of 9 cases showed slowed blood flow velocity of VA and basilar artery (BA) and peak backwards in 5 cases (5/9). Digital subtraction angiography (DSA) of 13 cases showed VA stenosis in 9 cases (9/13) and PICA stenosis in 2 cases (2/13). Six cases (16.67% ) were treated by intravenous thrombolysis, and 30 cases (83.33%) were treated by comprehensive medical treatment. Of all patients, 34 cases (94.44%) were significantly improved, including 18 cases with reduced symptoms, 6 cases with residual sensory disturbance, 6 cases with residual positive Horner sign, 4 cases with residual ataxia. Two cases (5.56% ) died of circulatory failure. Conclusions The clinical manifestations of Wallenberg syndrome are varied, only some patients have typical manifestations, therefore, the definite diagnosis needs to be combined by imaging examination. The clinical prognosis is related to the location, area of infarcts and complications. 

Key words: Lateral medullary syndrome, Posterior inferior cerebellar artery (not in MeSH), Vertebral artery, Magnetic resonance imaging