Clinical And Imaging Analysis Of Bilateral Medial Medullary Infarction

Background and Purpose:Neurology infarction is the most common acute ischemic cerebrovascular disease,with the development of scientific and technological progress and social productivity,improve people’s living standards and quality of life,changes in diet, change habits, so cerebrovascular the incidence of the disease increases every year, the trend is gradually youth, and its high incidence, high morbidity, high mortality and high recurrence rates tend to be a serious threat to people’s life and health and quality of life, family and society enormous economic and physical and psychological burden.Medullary infarction in the posterior circulation infarction is a rare type, accounting for about 4-5% posterior circulation ischemic stroke, the most common type is the Wallenberg portion infarction, and bilateral medial medullary infarction(bilateral medial medullary infarction, BMMI) relatively rare, its clinical manifestations of complex and diverse, and has the characteristics of easy progress, if the lack of support on the basis of imaging prone to misdiagnosis, so early diagnosis and treatment of the disease is important. This paper discusses bilateral medial medullary infarction clinical manifestations and imaging features, analysis summed up the law,aimed at deepening understanding of the clinical bilateral medial medullary infarction,provide some help with the theoretical basis for clinical diagnosis and treatment.Materials and Methods:Collect 16 cases from August 2011 to March 2016 in hospital diagnosis and treatment of Neurology Hospital of Jilin University in the first bilateral medial medullary infarction in patients with clinical data, their age, sex, risk factors, past history, clinical manifestations, and head CT MRI, vascular examination, treatment and prognosis were analyzed retrospectively.Result:1. This group of bilateral medial medullary infarction patients, 13 males (81.25%) and 3 females(18.75%), age 37-73 years, mean age(57.31 ± 9.68) years;accompanied by hypertension in 12 patients( 75.00%), history of diabetes five cases(31.25%), history of heart disease in 2 cases(12.50%), history of cerebral infarction 5cases(31.25%), smoking history of 11 cases(68.75%), drinking history in 3 cases(18.75%), accompanied by dyslipidemia in 7 cases(43.75%), high homocysteine 4cases(25.00%), cerebrovascular disease and a family history of one case(6.25%).2. This group of patients were acute onset, 11 patients showed a progressive course of disease, 11 cases the first symptom of dizziness, unconsciousness 3 cases,including 1 case of drowsiness, lethargy one case, in a coma in 1 case, 7 cases of weakness onset, seven cases of unilateral limb weakness, one case of lower extremity weakness. The group of major clinical manifestations were quadriplegic, dysarthria,bucking and bilateral pathological signs were positive, 15 patients were not arise extent limb paralysis, which manifested as lower extremity weakness one case; one patient showed only dizziness, no limb paralysis symptoms; dizziness in 11 cases,nausea and vomiting in 8 cases, 15 cases of dysarthria, drinking cough in 13 cases,dysphagia in 8 cases, diplopia in 1 case, nystagmus in 7 cases, nystagmus patients horizontal nystagmus in 6 cases, 1 case of rotary nystagmus, deep sensory disturbance in 6 cases, bilateral pathological positive in 13 cases; urinary disorders in 7 cases,including six cases of dysuria, urinary incontinence in 1 case.3.16 patients were shown DWI head MRI imaging bilateral medial medullary high signal intensity, 12 patients underwent MRA examination, 5 cases of bilateral vertebral artery, basilar artery stenosis or occlusion, the presence of two cases of abnormal blood vessels, which 1 case of left vertebral artery into the brain is not fine,right vertebral artery separately formed basilar artery, 1 case of extending the right vertebral artery directly under bilateral cerebellar artery, left vertebral artery is a continuation of the basilar artery, the cases patients with multiple basilar artery stenosis, and 1 side of the vertebral artery occlusion, and 1 side of the vertebral artery,basilar artery stenosis innings limit. One case of unilateral vertebral artery visible development slender, two cases MRA revealed no abnormalities.Conclusions:1.Bilateral medial medullary infarction to males, the common risk factors for hypertension, diabetes, dyslipidemia, smoking, drinking and so on.2. The typical clinical manifestations of bilateral medial medullary infarction is substantially symmetrical limb paralysis, dysarthria, choking water, deep sensory disturbances, bilateral pathological sign positive, may be associated with nystagmus,urinary disorders and other atypical symptoms, easy disease progression, severe life-threatening breathing difficulties.3. Bilateral medial medullary infarction is relatively rare in clinical posterior circulation ischemic lesions, early MRI diffusion-weighted imaging is the main imaging methods.