| Purpose:To investigate the relationship between the clinical characteristics and prognosis of patients with acute medullary infarction. Method:We collected 71 cases of patients who were treated in The Second Affiliated Hospital of Jilin University and diagnosed as acute medullary infarction by MRI from September,2015 to December,2015.Clinical data were collected, which including general information, risk factors, clinical symptoms and the lesion location of medullary infarction(axial and sagittal infarction), complications, situation of vascular stenosis. All patients were given the assessment with NIHSS scores at their admission day and discharged day. The patients were given the modified Rankin disability score scale(modified Rankin disability, m RS) 90 days visiting or by telephone. The patients were divided two groups according the m RS score. The m RS is less than or equal to 2 points called the good prognosis group, m RS > 2 named poor prognosis group. The measurement data was analyzed statisticly by t-test and enumeration data by chi-square test, P < 0.05 indicated that there was statistical significance, and then carried out spearman analysis to those results. Result:1. A total of 71 cases meet the inclusion criteria..About axial medullary infarction, medial infarction in 14 cases, lateral infarction of 50 cases, unilateral infarction in 5 cases, bilateral infarction in 2 cases; about sagittal infarction, 36 cases with superior infarction, middle infarction in 19 cases, inferior infarction in 10 cases, mixed infarction in 6 cases; only medulla oblongata infarction in 51 cases, oblongata infarction with other infarcts in 20 cases. Good prognosis group(MRS ≤ 2) were 45 cases, poor prognosis group were(MRS >2) in 26 cases.2. We found 58 cases of hypertension. The frequency of symptoms were dizziness or vertigo in 57 cases(80.3%), nausea and vomiting in 35 cases(49.3%), hoarseness in 35 cases(49.3%), and limb weakness in 26 cases(36.6%), limb weakness in 22 cases(31.0%), water choke cough in 18 cases(25.5%), dysphagia in 16 cases(22.5%), facial numbness in 11 cases(15.5%), headache in 5 cases(7.0%), double visual in 3 cases(4.2%). The frequency of physical signs were Ataxia in 40 cases(56.3%), constitutive dysarthria in 33 cases(46.5%), Horner syndrome in 30 cases(42.3%), facial sensory impairment in 30 cases(42.3%), facial paralysis in29 cases(40.8%), nystagmus in 29 cases(40.8%) and limb paralysis in 26 patients(36.6%), soft palate paralysis in 24 cases(33.8%), cross sensory disturbance in 21 cases(29.6%), tongue paralysis in 16 cases(22.5%), gaze palsy in 6 cases(8.5%), and diplopia in 3 cases(4.2%). In addition, pulmonary infection were found 19 cases(26.8).3. Comparison between groups: hypertension(P=0.039) has significant difference between the two groups; the admission NIHSS(P=0.010), discharge NIHSS(P=0.040) between the two groups was significant; limb weakness( P=0.000), dysphagia(P=0.009) there are significant differences between the two groups; facial paralysis(P=0.028), tongue paralysis(P=0.015), Horner syndrome(P=0.034), the soft palate and laryngeal muscle paralysis(P=0.028), cross sensory disorder(P=0.020). There are significant differences between the two groups in the bilateral cerebral infarction;(P=0.020) there are significant differences between the two groups; non pure medullary infarction(P=0.044) there are significant differences between the two groups;(P=0.020), pulmonary infection(P=0.013), stress ulcer(P=0.037) were significantly different in the two groups; basilar artery stenosis(P=0.013) there are significant differences in the two groups.4. The comparison between groups showed a statistically significant difference between the project Spearman correlation analysis. The results showed that the limb weakness / paralysis of limbs(HR=0.360, P = 0.002), dysphagia(HR=0.258, P = 0.030), facial paralysis(HR=0.301, P = 0.011), tongue paralysis(HR=0.296, P = 0.011), pulmonary infection(HR=0.309, P = 0.009) had positive correlation with poor prognosis and showed significant statistical difference. Conclusion:1. Typical medullary syndrome was rare, the most common risk factors was hypertension, the most common symptom was dizziness or vertigo, the most common sign was ataxia, the most common complication was pulmonary infection, lateral medullary infarction is more common to see than the medial medullary infarction, superior medulla infarction happened more often than middle and inferior infarct.2. The poor prognosis of patients with medullary infarction were mostly caused by the following factors: limb paralysis / weakness, pulmonary infection, facial paralysis, tongue paralysis, dysphagia.3. The comprehensive rehabilitation treatment of dysphagia and limb dysfunction might improve the prognosis of patients with medullary infarction. |
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