發(fā)布時(shí)間：2018-03-18 08:09

  本文選題：延髓背外側(cè)綜合征　切入點(diǎn)：腦梗塞　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討延髓背外側(cè)綜合征（Wallenberg syndrome）的病因、危險(xiǎn)因素、臨床表現(xiàn)、影像學(xué)特點(diǎn)及預(yù)后等方面的特點(diǎn)。 方法：收集2012年3月-2014年2月在我院神經(jīng)內(nèi)科住院的30例Wallenberg綜合征患者的臨床資料，對(duì)其病因、危險(xiǎn)因素、臨床表現(xiàn)、影像學(xué)檢查、血管方面檢查和預(yù)后等資料進(jìn)行回顧性分析，并同以往文獻(xiàn)進(jìn)行比較。 結(jié)果： 1.本組Wallenberg綜合征危險(xiǎn)因素由高到低依次為高血脂、高血壓、長(zhǎng)期煙酒史、高血糖及心臟病病史。 2.本組Wallenberg綜合征臨床表現(xiàn)按出現(xiàn)頻率依次為構(gòu)音障礙、吞咽困難、眩暈、共濟(jì)失調(diào)、Horner征、感覺障礙、眼震及呃逆。其他不典型癥狀包括：頭痛、中樞性面癱、肢體輕癱、病理征陽(yáng)性及復(fù)視。 3.本組Wallenberg綜合征病程中出現(xiàn)的合并癥依次為肺部感染、應(yīng)激性潰瘍、心律失常和電解質(zhì)紊亂等。 4.本組30例Wallenberg綜合征中，有29例行頭部MRI檢查發(fā)現(xiàn)延髓背外側(cè)新發(fā)梗塞，有1例僅行頭部CT檢查，腦干內(nèi)未發(fā)現(xiàn)責(zé)任病灶。21例患者行血管方面檢查，發(fā)現(xiàn)病灶同側(cè)椎動(dòng)脈有不穩(wěn)定斑塊、血管狹窄或發(fā)育纖細(xì)的有12例；發(fā)現(xiàn)同時(shí)存在雙側(cè)椎動(dòng)脈有上述病變的2例；發(fā)現(xiàn)僅病灶對(duì)側(cè)椎動(dòng)脈或頸內(nèi)動(dòng)脈系統(tǒng)血管有不穩(wěn)定斑塊或血管狹窄的有6例；有1例血管方面檢查未發(fā)現(xiàn)異常。 5.本組30例患者經(jīng)系統(tǒng)治療2-3周后27例病情好轉(zhuǎn)出院，出院時(shí)未完全恢復(fù)的依次為Horner征、感覺障礙、構(gòu)音障礙及吞咽功能障礙。3例在病情相對(duì)穩(wěn)定且患者意識(shí)清楚狀態(tài)下出現(xiàn)呼吸驟停臨床死亡（10%）。 結(jié)論： 1.高血脂、高血壓、長(zhǎng)期煙酒史、高血糖及心臟病病史是Wallenberg綜合征最常見的危險(xiǎn)因素，與缺血性腦血管病的危險(xiǎn)因素大致相同。 2.患者在具備Wallenberg綜合征的經(jīng)典癥狀的同時(shí)，還可出現(xiàn)其他不典型癥狀如中樞性面癱、肢體輕癱等。 3.Wallenberg綜合征患者較其他部位梗塞更容易出現(xiàn)合并癥。 4.本組Wallenberg綜合征的病因均為梗塞。發(fā)現(xiàn)患者存在病灶同側(cè)椎動(dòng)脈病變的比例較高，，有可能是本綜合征的責(zé)任血管。 5.Wallenberg綜合征預(yù)后相對(duì)較好，但Horner征、感覺障礙、構(gòu)音障礙及吞咽功能障礙癥狀恢復(fù)較慢。本病的主要死因?yàn)楹粑E停，且其發(fā)生率較其他部位梗塞高。
[Abstract]:Objective: to investigate the etiology, risk factors, clinical manifestations, imaging features and prognosis of Wallenberg syndrome of dorsolateral medulla oblongata. Methods: the clinical data of 30 patients with Wallenberg syndrome were collected from March 2012 to February 2014. The etiology, risk factors, clinical manifestations and imaging findings were analyzed. The data of vascular examination and prognosis were analyzed retrospectively and compared with previous literatures. Results:. 1. The risk factors of Wallenberg syndrome from high to low were hyperlipidemia, hypertension, long history of tobacco and alcohol, hyperglycemia and heart disease. 2. The clinical manifestations of Wallenberg syndrome were dysarthria, dysphagia, vertigo, ataxia Horner's sign, sensory disturbance, nystagmus and hiccup. Other atypical symptoms included headache, central facial paralysis and limb paresis. Positive pathological signs and diplopia. 3. The complications of Wallenberg syndrome were pulmonary infection, stress ulcer, arrhythmia and electrolyte disturbance. 4. Of the 30 cases of Wallenberg syndrome, 29 cases were found to have new infarction on the dorsolateral medulla by MRI, 1 case by CT, and 21 cases by blood vessel examination in the brain stem. Unstable plaques of ipsilateral vertebral artery were found in 12 cases with stenosis or fine development of vertebral artery in 12 cases, and 2 cases with bilateral vertebral artery were found to have these lesions at the same time. It was found that 6 cases had unstable plaques or stenosis in the contralateral vertebral artery or internal carotid artery system, and 1 case had no abnormality in vascular examination. 5.Twenty three weeks after systematic treatment, 27 patients were discharged from hospital, and the Horner signs and sensory disorders were not recovered completely at the time of discharge. Patients with dysarthria and dysphagia had clinical death of sudden respiratory arrest under the condition of relatively stable condition and clear consciousness. Conclusion:. 1. Hyperlipidemia, hypertension, long history of tobacco and alcohol, hyperglycemia and heart disease were the most common risk factors of Wallenberg syndrome, which were similar to those of ischemic cerebrovascular disease. 2. Other atypical symptoms such as central facial paralysis, limb paresis and so on may occur in patients with Wallenberg syndrome. 3. Wallenberg syndrome patients are more likely to develop complications than other infarcts. 4. The etiology of Wallenberg's syndrome was infarction. It was found that the proportion of ipsilateral vertebral artery lesions was higher, which might be the responsible blood vessel of this syndrome. 5. The prognosis of Wallenberg syndrome was relatively good, but the symptoms of Horner sign, sensory disturbance, dysarthria and dysphagia recovered slowly. The main cause of death was respiratory arrest, and its incidence of infarction was higher than that of other parts.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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