| Objective: This study aims to investigate the clinical characteristics and pathogenesis of lateral medullary infarction(LMI)and medial medullary infarction(MMI),and their relationship with clinical prognosis.Methods: Selected patients who were admitted to the Second Affiliated Hospital of Dalian Medical University from September 2018 to November 2020 and were confirmed to be acute medullary infarction(MI)by cranial magnetic resonance diffusion-weighted imaging(DWI)as the research object,a total of 71 example.According to the affected parts of the lesion on DWI images,it can be divided into LMI group and MMI group,and general demographic data,clinical manifestations,and imaging data of all patients are collected.According to Chinese ischemic stroke subclassification(CISS)classify the pathogenesis of the enrolled patients.The outpatient follow-up was performed 3 months after the patient was discharged,and the modified Rankin Scale(m RS)was used to evaluate the prognosis of the patient.If m RS >2points,it is defined as a poor prognosis,and m RS ≤ 2 points is defined as a good prognosis.The SPSS software was used to analyze the data of the LMI and MMI two groups,and the chi-square test and t test were used to compare the differences in general data,clinical manifestations,imaging data,and pathogenesis between the LMI and MMI two groups;then the LMI was scored according to the m RS score For the good prognosis group and the poor prognosis group,logistic regression analysis was used to screen out independent risk factors affecting the prognosis of LMI.Similarly,according to the m RS score,MMI was divided into a good prognosis group and a poor prognosis group,and logistic regression analysis was used to screen out independent risk factors affecting the prognosis of MMI.Results: 1.Among the patients included in the study,LMI was 48(67.6%)and MMI was 23(32.4%).A univariate analysis of demographic data between the two groups showed that the average age of onset of LMI was(61.8±11.5)years,and the proportion of patients with diabetes was 39.6%;the average age of onset of MMI was(69.0±11.0)years,with diabetes The proportion of patients was 65.2%;the average age of onset of MMI and the prevalence of diabetes were significantly higher than those of the LMI group,and the differences were statistically significant(P=0.014,P=0.043);the clinical symptoms and signs between the two groups were single factors The analysis showed that: in MMI,there were 16 patients(69.6%)with limb paralysis,which was significantly higher than that in the LMI group(21 patients,43.8%),and the difference was statistically significant(P=0.042).Water choking and ataxia were 17 cases(35.4%)and 22(45.8%)in the LMI group,respectively.In MMI,water choking and ataxia were3 cases(13.0%)and 5 cases(21.7%),drinking coughing and dysphagia were more common in the LMI group,but it was not statistically significant(P=0.05);the univariate analysis of the distribution of infarct lesions on the longitudinal axis of LMI and MMI patients found that the distribution of infarct lesions on the longitudinal axis between the two groups was also statistically different(P=0.003);2.The analysis of the relationship between different pathogenesis and clinical and imaging characteristics in the LMI and MMI groups showed that: age,diabetes,and early neurological deterioration(END)and vertical axis classification(upper section-lower section)were not statistically different among different pathogenesis.3.Single-factor screening of factors that may affect the prognosis of LMI showed that:hypertension,diabetes,early neurological deterioration(END),pathogenesis and infarct location are closely related to poor prognosis,and then multi-factor regression analysis found: END It may be an independent risk factor for poor prognosis(OR=53.053,95%CI=1.082-2602.034,P=0.046);in the pathogenesis,compared with perforating artery disease(PAD),large atherosclerosis(LAA)may be an independent risk factor for poor prognosis(OR=24.106,95%CI=1.334-435.507,P=0.031).Single-factor screening of factors that may affect the prognosis of MMI showed that END and pathogenesis are related to poor prognosis.Multivariate regression analysis found that LAA(compared with PAD)may be an independent risk factor for poor prognosis(OR=38.284,95%CI=1.632-897.944,P =0.024).Conclusion:1.Compared with LMI,the average age of onset of MMI patients is older and the prevalence of diabetes is higher.2.The most common clinical symptoms and signs of MMI are paralysis of the limbs.On the longitudinal axis,the infarct lesions of MMI are more common in the upper medulla oblongata.3.In LMI,early neurological deterioration and LAA(compared with PAD)may be independent risk factors for poor prognosis.4.In MMI,LAA(compared to PAD)may be an independent risk factor for poor prognosis. |
PDF Full Text Request