摘要： 目的 双侧延髓内侧梗死易误诊，本研究总结其临床特点以及诊断与治疗经验，以为临床诊断与鉴别诊断疾病提供参考。方法与结果 上海交通大学医学院附属瑞金医院北部院区2017年1月至2022年1月收治3例双侧延髓内侧梗死患者，均为急性起病，分别以急性脊髓炎样表现发病（快速进展性四肢瘫，1例）、顽固性呃逆发病（1例）、偏侧肢体麻木乏力首发伴舌下神经瘫（1例）。头部MRI显示双侧延髓内侧梗死（1例早期MRI未见梗死灶）。2例因出现下运动神经元损害体征或症状不典型而误诊（例1、例2）。予以抗栓治疗后症状好转。结论 急性双侧延髓内侧梗死临床表现多样，早期易误诊，明确诊断需依靠临床表现及头部MRI检查，应早期准确诊断，及时予以针对急性脑梗死的抗栓治疗。鉴别要点主要为是否具有脑卒中危险因素，有无上运动神经元损害体征，治疗是否有效。

关键词: 延髓, 脑梗死, 脑血管障碍

Abstract: Objective Bilateral medial medullary infarction (MMI) is prone to misdiagnosis. This study summarizes the clinical characteristics of MMI, in order to provide reference to clinicians. Methods and Results The clinical data of the 3 patients with acute bilateral MMI treated in Ruijin Hospital North Campus affiliated to Shanghai Jiaotong University School of Medicine from January 2017 to January 2022 were collected. All 3 patients had acute onset, one case had acute myelitis-like manifestations (rapidly progressive quadriplegia), one case had intractable hiccup, and the other one had unilateral limb numbness and fatigue as the first manifestation, accompanied by hypoglossal palsy. The head MRI showed acute bilateral MMI (one case without acute lesions on early MRI). Two cases were misdiagnosed because of either presenting lower motor neuron damage signs or having atypical symptoms. All patients improved after antithrombotic therapy for acute cerebral infarction. Conclusions The clinical manifestations of acute bilateral MMI are diverse, and it's easy to be misdiagnosed in the early stage. The diagnosis is mainly based on clinical manifestations and head MRI, which requires early recognition and timely antithrombotic treatment for acute cerebral infarction. The main distinguishing points are whether there are risk factors for stroke, upper motor neuron damage signs, and the treatment was effective.

Key words: Medulla oblongata, Brain infarction, Cerebrovascular disorders