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Clinical and Imaging Analyses of Medullary Infarction in43Cases

Author: XuLinZuo
Tutor: YinLin
School: Dalian Medical University
Course: Neurology
Keywords: Medullary Infarction Clinical Characteristics Imaging Medullary Syndrome
CLC: R743.3
Type: Master's thesis
Year: 2013
Downloads: 20
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Abstract


Background and objective: Medulla oblongata is at the most interior extremity ofthe brainstem and its anatomic structure is complex. The clinical manifestations ofmedullary infarction are sophisticated and diverse, most of which are untypical. Misseddiagnosis and misdiagnosis could easily happen, without imaging evidence. Thepurpose of our study was to retrospectively analyze the clinical manifestation and theimaging results of medullary infarction to further understand its clinical and imagingcharacteristics and to deepen our knowledge of medullary infarction.Methods: Clinical datas and imaging data in43cases with medullary infarctionwere analyzed retrospectively. Among43cases,31(72.09%) were male and12(27.91%)were female, with a mean age of63.80years (range30-90). Each ischemic diagnosiswas proved by cranial MRI. According to different anatomical levels, medullaoblongata was divided into five anatomical planes-the conjoin of pons and medullaoblongata, the upper segment, the middle segment (hypoolive and centre), the bottomsegment, the conjoin of medulla oblongata and cervical cord. Each plane was furtherdivided into5locations on axial plane: ventral lateral, ventral medial, dorsal lateral,dorsal medial and centre. Parametters analyses mainly included the location, number,shape, and distribution of lesions in each case. The clinical symptoms and signs weresummarized. The relationship of infarction location and medullary syndrome wasanalyzed in details. Through all above, the clinical and imaging characteristics wereexplored in medullary infarction.Results:①T hecase group consisted of31(72.09%) men and12(27.91%)women. As risk factors,31(72.09%) case had hypertension,27(62.79%) hadatherosclerosis,19(44.19%) had diabetes,18(41.86%) had hyperlipidemia,16(37.21%)had a history of smoking,16(37.21%) had a history of lacunar infarction,10(23.26%) had a history of alcohol drinking,4(9.30%) had atrial fibrillation,3(6.98%) hadhomocysteinemia, and2(4.65%) had coronary heart disease.②Primary clinicalmanifestations of patients with medullary infarction were complex and diverse,including such most common manifestations as superficial sensory disturbance in24cases (55.81%), dizziness in23(53.49%), regurgitation in21(48.84%), nausea orvomiting in19(44.19%), dysphagia in18(41.86%), dysarthria in17(39.53%), and gagreflex absence in17(39.53%).③Ischemic lesions were found in the upper segment ofmedulla oblongata in16cases (37.21%),17(39.53%) in the middle segment,7(16.28%)in the bottom segment,2(4.65%) in both upper and middle segments, and only1(2.33%)in both middle and bottom segments. Lesions were found in the dorsal lateral aspect ofmedulla oblongata in36cases (83.72%), in the ventral medial in6(13.95%), and in thedorsal medial in1(2.33%).④Classical medullary syndromes including Wallenbergsyndrome was only presented in7cases, Dejerine syndrome in1case,and Avellissyndrome in1case.Conclusions:①Medullary infarction is more common in men. Hypertension,atherosclerosis, diabetes and hyperlipidemia are the most important risk factors.②Themost common clinical manifestations of medullary infarction are superficial sensorydisturbance and ischemic symptoms of post circulation the such as dizziness,regurgitation, nausea or vomiting, dysphagia, dysarthria and gag reflex absence.Classical medullary syndromes are relatively infrequent.③Ischemic lesion is mostcommonly found in the middle and upper segments of medulla oblongata, mainly in thedorsal lateral aspect.④B rain MRI examination plays a significant role in the diagnosisof medullary infarction.

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CLC: > Medicine, health > Neurology and psychiatry > Neurology > Cerebrovascular disease > Acute cerebrovascular disease ( stroke)
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