Clinical And Imaging Analysis Of 22 Patients With Medulla Oblongata Infarction

Objective:Methods: Twenty-two patients with medullary infarction diagnosed by imaging from January 2018 to January 2020 in our department and the time from onset to diagnosis was less than 2 weeks were enrolled.The purpose of this study was to analysize the diagnosis and prognosis effect of clinical and imaging features in patients with medullary infarction.We aim to study the clinical characteristics,imaging findings,and the clinical characteristics and prognosis of patients with high signal intensity in blood vessels,so as to further understand the clinical and imaging characteristics of medullary infarction and improve the understanding of medullary infarction.Method:Demography(age,gender),clinical manifestations(onset mode,first symptom,clinical symptoms and signs),risk factors,onset time,extended NIHSS score on admission,craniocerebral MRI,MRA,High Resolution Magnetic Resonance Imaging(HRMRI),prognosis and other clinical data were retrospectively analyzed.Result:1.in the cases of medial medullary infarction,male and female were 3.5:1,median age was 64 years,and the average age of onset was(64.8 soil 10.99).In lateral medullary infarction,the male: female was 5.5:1,the median age was 57 years,and the average age of onset was(59.76 soil 12.61).2.15 cases of quiet onset and 7 cases of active onset were acute onset(within 2weeks),and the average time from onset to diagnosis was 1.56 days.The results showed that there were 2 cases(9%),8(36.4%),7(31.8%),5(23%),3(14%),1(5%),8(36.4%),2(9%)with weakness of limbs,hemiplegia,dizziness,headache,dysarthria,facial paralysis,hemisensory disorder and ataxia respectively.There was no significant difference in the initial performance between LMI and MMI(P > 0.05).3.In this study,LMI group was more likely to have shallow sensory disturbance than MMI group(P < 0.05).MMI group was more prone to limb hemiplegia than LMI group(P < 0.05).There was no significant difference in symptoms and signs ofdizziness,headache,dysarthria,dysphagia,ataxia,pathological signs,quadriplegia and facial paralysis between the two groups(P > 0.05).4.In this study,9 cases(40.9%)of high signal intensity were found in the vertebral artery and basilar artery by MRI plain scan,including 1 case in the MMI group and 8 cases in the LMI group.Of the 22 patients with medulla oblongata infarction,7 cases(32%)showed slight atherosclerosis of vertebral artery,13 cases(59.1%)showed severe stenosis or occlusion of vertebral artery,and the remaining 2cases(8.9%)showed no obvious stenosis or occlusion of vertebral artery,no hematoma or aneurysm.In craniocerebral MRI plain scan,9 cases(40.9%)of medulla oblongata infarction had high signal in T1 vessels and no empty signal in T2 vessels,and 13 cases(59.1%)of medulla oblongata infarction had no high signal in vessels.5.In this study,we found that the patients with intravascular hyperintensity had a modified NIHSS(e-nihss score),with one patient mild grade(e-nihss score less than4),one patient moderate grade(4-7points),and a severe grade(greater than 7 points)in7 patients;there were 13 patients without intravascular hyperintensity,including 10 mild patients,3 moderate patients and 0 severe patients.The e-nihss score of patients with intravascular high signal was significantly higher than that of patients without high signal(P < 0.05).6.In this study,9 patients with intravascular high signal of vertebral artery and basilar artery were found in plain MRI scan.13 cases of severe stenosis or occlusion were confirmed by MRA.The specificity and sensitivity of craniocerebral MRI in the diagnosis of severe stenosis or occlusion of vertebral artery and basilar artery were100% and 69.2% with high intravascular signal.7..In this study,among the patients with improved high-resolution imaging of vertebrobasilar artery,4 cases were found to have intravascular thrombosis,including one case of thrombosis caused by vertebral artery dissection.There was no significant difference in the detection of intravascular thrombosis between HRMRI and MRI plain scan of vertebral artery and basilar artery(P > 0.05).8.In this study,14 patients(63.64%)had a good prognosis,including 7 patients in the LMI group and 7 patients in the MMI group,and 3 patients were found to have high signal in the blood vessels.Eight patients(36.36%)suggested poor prognosis,including 6 in the LMI group and 2 in the MMI group,and 6 in the intravascular hypersignal.After adjusting for age and gender,there were significant differences in prognosis between the LMI group and the MMI group(P=0.045).The prognosis of medulla oblongata infarction with intravascular hyperintensity compared with that without intravascular hyperintensity was statistically different in corrected chi-square test(χ2=0.269,P<0.05).However,after adjusting for age and sex,logistic regression showed no statistically significant difference between the groups(P=0.535).Conclusion:1.Routine cerebral magnetic resonance plain scanning found that intravascular high signal sign had high clinical specificity,and intravascular high signal confirmed the existence of severe vascular stenosis or occlusion,which was consistent with the results of MRA;Intravascular high signal sign(vertebral artery thrombosis)was more likely to have lateral medullary infarction and NIHSS score was heavier than those without intravascular high signal.2.The prognosis of the lateral medulla oblongata infarction group was worse than that of the medial medulla oblongata infarction group,and the prognosis of the medulla oblongata infarction with intradascular high signal sign was worse than that of the non-intradascular high signal group,but there was no statistical difference.