延髓背外侧综合征30例临床分析

发布时间：2018-03-18 08:09

本文选题：延髓背外侧综合征　切入点：脑梗塞　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨延髓背外侧综合征（Wallenberg syndrome）的病因、危险因素、临床表现、影像学特点及预后等方面的特点。方法：收集2012年3月-2014年2月在我院神经内科住院的30例Wallenberg综合征患者的临床资料，对其病因、危险因素、临床表现、影像学检查、血管方面检查和预后等资料进行回顾性分析，并同以往文献进行比较。结果： 1.本组Wallenberg综合征危险因素由高到低依次为高血脂、高血压、长期烟酒史、高血糖及心脏病病史。 2.本组Wallenberg综合征临床表现按出现频率依次为构音障碍、吞咽困难、眩晕、共济失调、Horner征、感觉障碍、眼震及呃逆。其他不典型症状包括：头痛、中枢性面瘫、肢体轻瘫、病理征阳性及复视。 3.本组Wallenberg综合征病程中出现的合并症依次为肺部感染、应激性溃疡、心律失常和电解质紊乱等。 4.本组30例Wallenberg综合征中，有29例行头部MRI检查发现延髓背外侧新发梗塞，有1例仅行头部CT检查，脑干内未发现责任病灶。21例患者行血管方面检查，发现病灶同侧椎动脉有不稳定斑块、血管狭窄或发育纤细的有12例；发现同时存在双侧椎动脉有上述病变的2例；发现仅病灶对侧椎动脉或颈内动脉系统血管有不稳定斑块或血管狭窄的有6例；有1例血管方面检查未发现异常。 5.本组30例患者经系统治疗2-3周后27例病情好转出院，出院时未完全恢复的依次为Horner征、感觉障碍、构音障碍及吞咽功能障碍。3例在病情相对稳定且患者意识清楚状态下出现呼吸骤停临床死亡（10%）。结论： 1.高血脂、高血压、长期烟酒史、高血糖及心脏病病史是Wallenberg综合征最常见的危险因素，与缺血性脑血管病的危险因素大致相同。 2.患者在具备Wallenberg综合征的经典症状的同时，还可出现其他不典型症状如中枢性面瘫、肢体轻瘫等。 3.Wallenberg综合征患者较其他部位梗塞更容易出现合并症。 4.本组Wallenberg综合征的病因均为梗塞。发现患者存在病灶同侧椎动脉病变的比例较高，，有可能是本综合征的责任血管。 5.Wallenberg综合征预后相对较好，但Horner征、感觉障碍、构音障碍及吞咽功能障碍症状恢复较慢。本病的主要死因为呼吸骤停，且其发生率较其他部位梗塞高。
[Abstract]:Objective: to investigate the etiology, risk factors, clinical manifestations, imaging features and prognosis of Wallenberg syndrome of dorsolateral medulla oblongata. Methods: the clinical data of 30 patients with Wallenberg syndrome were collected from March 2012 to February 2014. The etiology, risk factors, clinical manifestations and imaging findings were analyzed. The data of vascular examination and prognosis were analyzed retrospectively and compared with previous literatures. Results:. 1. The risk factors of Wallenberg syndrome from high to low were hyperlipidemia, hypertension, long history of tobacco and alcohol, hyperglycemia and heart disease. 2. The clinical manifestations of Wallenberg syndrome were dysarthria, dysphagia, vertigo, ataxia Horner's sign, sensory disturbance, nystagmus and hiccup. Other atypical symptoms included headache, central facial paralysis and limb paresis. Positive pathological signs and diplopia. 3. The complications of Wallenberg syndrome were pulmonary infection, stress ulcer, arrhythmia and electrolyte disturbance. 4. Of the 30 cases of Wallenberg syndrome, 29 cases were found to have new infarction on the dorsolateral medulla by MRI, 1 case by CT, and 21 cases by blood vessel examination in the brain stem. Unstable plaques of ipsilateral vertebral artery were found in 12 cases with stenosis or fine development of vertebral artery in 12 cases, and 2 cases with bilateral vertebral artery were found to have these lesions at the same time. It was found that 6 cases had unstable plaques or stenosis in the contralateral vertebral artery or internal carotid artery system, and 1 case had no abnormality in vascular examination. 5.Twenty three weeks after systematic treatment, 27 patients were discharged from hospital, and the Horner signs and sensory disorders were not recovered completely at the time of discharge. Patients with dysarthria and dysphagia had clinical death of sudden respiratory arrest under the condition of relatively stable condition and clear consciousness. Conclusion:. 1. Hyperlipidemia, hypertension, long history of tobacco and alcohol, hyperglycemia and heart disease were the most common risk factors of Wallenberg syndrome, which were similar to those of ischemic cerebrovascular disease. 2. Other atypical symptoms such as central facial paralysis, limb paresis and so on may occur in patients with Wallenberg syndrome. 3. Wallenberg syndrome patients are more likely to develop complications than other infarcts. 4. The etiology of Wallenberg's syndrome was infarction. It was found that the proportion of ipsilateral vertebral artery lesions was higher, which might be the responsible blood vessel of this syndrome. 5. The prognosis of Wallenberg syndrome was relatively good, but the symptoms of Horner sign, sensory disturbance, dysarthria and dysphagia recovered slowly. The main cause of death was respiratory arrest, and its incidence of infarction was higher than that of other parts.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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