Wallenberg综合征16例临床分析

发布时间：2018-10-17 19:55

【摘要】：研究背景： Wallenberg综合征又称延髓背外侧综合征,是脑干梗死中最常见的类型之一。由于小脑后下动脉(Posterior Inferior Cerebellar Artery, PICA)血管解剖变异性大,病灶范围大小不一,所以该综合征患者的临床症状轻重程度差别较大,大多数症状轻,预后良好；少数症状重,预后差,常因中枢性呼吸衰竭而亡[1]。以往认为Wallenberg综合征是PICA闭塞的结果,随着近些年影像学技术的不断发展,大家对Wallenberg综合征的解剖学、病因及发病机制、临床表现等方面有了许多新的认识,已意识到PICA并非是导致该综合征的唯一原因。为了探讨该综合症的规律,改进治疗措施,提高诊治水平,故而收集了2013年1月～2013年11月在我院住院的16例Wallenberg综合征患者的临床资料,进行总结和分析。目的探讨Wallenberg综合征的血管解剖、病因及危险因素、临床表现、影像学特点、诊断及治疗、并发症和预后,提高对该综合征的认识和早期诊断率。方法收集浙江大学医学院附属第二医院2013年1月～11月在神经内科住院并经MRI确诊的Wallenberg综合征患者的临床资料,复习近期的国内外文献,对此综合征进行回顾性分析。结果 16例患者中男性10例,女性6例,年龄37～85岁,平均年龄55.5±9.5岁；主要病因是大动脉粥样硬化和心源性疾病；主要危险因素为高血压、高血糖、高脂血症、冠心病、心房颤动等；临床表现主要为眩晕、恶心、呕吐、球麻痹、交叉性感觉障碍、Horner征、同侧小脑性共济失调五大症状,以及听力减退、头痛、眼球运动障碍等少见表现；影像学MRI检查可为临床诊断提供可靠依据；治疗原则与缺血性脑血管病相同；大多数患者预后良好。结论由于PICA血管解剖变异性大,Wallenberg综合症临床表现复杂多变,我们除了掌握常见的五大经典症状外,还应熟悉其少见症状。早期诊断、早期治疗、积极控制危险因素及防治并发症是决定Wallenberg综合征预后的关键。
[Abstract]:Background: Wallenberg syndrome, also known as dorsolateral medullary syndrome, is one of the most common types of brainstem infarction. Because of the large anatomical variability of the (Posterior Inferior Cerebellar Artery, PICA) vessels of the posterior inferior cerebellar artery and the different size of the lesions, the clinical symptoms of the patients with the syndrome vary greatly, most of the symptoms are mild, and the prognosis is good, a few of the symptoms are serious and the prognosis is poor. Often die of central respiratory failure [1]. In the past, Wallenberg syndrome was considered to be the result of PICA occlusion. With the continuous development of imaging techniques in recent years, there have been many new understandings on the anatomy, etiology, pathogenesis, clinical manifestations and so on of Wallenberg syndrome. It is recognized that PICA is not the only cause of the syndrome. In order to discuss the regularity of the syndrome, improve the treatment measures and improve the level of diagnosis and treatment, the clinical data of 16 cases of Wallenberg syndrome hospitalized in our hospital from January 2013 to November 2013 were collected and analyzed. Objective to investigate the vascular anatomy, etiology and risk factors, clinical manifestations, imaging features, diagnosis and treatment, complications and prognosis of Wallenberg syndrome, and to improve the recognition and early diagnosis of Wallenberg syndrome. Methods the clinical data of patients with Wallenberg syndrome diagnosed by MRI in Department of Neurology from January to November 2013 in the second affiliated Hospital of Zhejiang University Medical College were collected and the recent literature at home and abroad were reviewed. The syndrome was analyzed retrospectively. Results among the 16 patients, 10 were male, 6 were female, the average age was 55.5 卤9.5 years old, the age was 370.85 years old, the main cause was arteriosclerosis and cardiogenic disease, the main risk factors were hypertension, hyperglycemia, hyperlipidemia, the main risk factors were hypertension, hyperglycemia, hyperlipidemia, hypertension, hyperglycemia and hyperlipidemia. The clinical manifestations were vertigo, nausea, vomiting, bulbar paralysis, cross sensory disorder, Horner sign, ipsilateral cerebellar ataxia, as well as hearing loss, headache, eye movement disorder, etc. Imaging MRI can provide reliable basis for clinical diagnosis; treatment principle is the same as ischemic cerebrovascular disease; most patients have a good prognosis. Conclusion due to the large anatomical variability of PICA and the complex and changeable clinical manifestations of Wallenberg syndrome, we should be familiar with the rare symptoms in addition to the five common classic symptoms. Early diagnosis, early treatment, active control of risk factors and prevention and treatment of complications are the key to the prognosis of Wallenberg syndrome.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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