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延髓外侧梗塞出现锥体束征不常见到,而锥体束征位于梗塞同侧更为罕见,作者报导一例。78岁男性,有高血压、糖尿病及心绞痛史。因突发恶心、呕吐、声音嘶哑入院。血压190/110mmHg 嗜睡,右侧中枢性面瘫、双侧咽反射消失、声音嘶哑、说话含糊、头向左转无力,右侧偏瘫,腱反射对称。双侧巴氏征(+)。CT 扫描正常。入院第三天呼吸抑制,第十三天死亡。尸检示右椎动脉末端血栓栓塞,左椎动脉硬化,迂曲扩张。基底动脉、willis 环、大脑前、中动脉均有粥样硬化。延髓冠状切面示右外侧梗死。但未累及锥体及近中线结构。延髓上部横断面可见左外侧梗死灶形成、苍白、坏死出血,累及三叉神经核及其纤维、疑核、弧束核、脊髓小脑束、脊丘束以及该区域其它结构。但近中线结构未累及。延髓下段及与颈髓交界处横断面示右外侧梗死区,累及锥体交叉。该例尽管临床资料不全,仍可定为延髓外侧受损。在该征候群中罕见的右侧面肌麻痹可解释为累及支配面神经核的皮质延髓束,胸锁乳突肌功能受累提示病变波及第Ⅺ颅神经。右侧偏瘫病理证实为累及同侧皮质脊髓束。因为该区域梗死的局限性,相
Ocular medullary infarction appears cone beam sign is not common, and pyramidal tract signs located on the ipsilateral infarct is more rare, the authors report a case. 78-year-old man with history of hypertension, diabetes and angina. Due to sudden nausea, vomiting, hoarseness admitted to hospital. Blood pressure 190 / 110mmHg drowsiness, right central paralysis, disappearance of bilateral pharyngeal reflex, hoarseness, vague speech, head turned left weakness, right hemiplegia, tendon reflex symmetry. Bilateral Pakistan sign (+). CT scan is normal. The third day of admission respiratory depression, the thirteenth day of death. Autopsy showed the right vertebral artery thromboembolism, left vertebral artery atherosclerosis, tortuous expansion. Basilar artery, willis ring, anterior cerebral artery, middle artery have atherosclerosis. Proximal coronal section shows the right lateral infarction. But did not affect the cone and near-midline structure. The medial medulla oblongata showed the formation of left lateral infarction, pale and necrotic hemorrhage, which involved the trigeminal nucleus and its fibers, nucleus accumbens, nucleus tractus, spinocerebellar tract, spine bundle and other structures in the area. However, the near-midline structure is not involved. Lateral medulla oblongata and the cross-section of the cervical cord showed the right lateral infarct, involving the cone cross. Despite the incomplete clinical data of this case, the medulla oblongata may still be impaired. The rare right facial muscle paralysis in this syndrome can be explained by involving the cortical medulla oblongata that dominate the facial nerve nucleus and the involvement of the sternocleidomastoid muscle suggests that the lesion affects the Ⅺ cranial nerve. The pathology of the right hemiplegia was confirmed as involving the ipsilateral corticospinal tract. Because of the limitations of infarction in this area, phase