PDF(Pubmed)
Abstract：
Bilateral medial medullary infarction (BMMI) is a rare stroke syndrome, which frequently has poor clinical outcomes. Reports on physical therapy for BMMI are few because of its poor prognosis. Therefore, this report aims to present a patient who developed BMMI and underwent well-considered rehabilitation. A 67-year-old man presented to our clinic with an acute onset of vomiting and dizziness. Magnetic resonance imaging (MRI) showed no abnormal signal intensity, and the patient was admitted for peripheral dizziness. On day two, he developed quadriplegia, bulbar palsy, and respiratory impairment, such as prolonged apnea. A second MRI revealed a high-intensity lesion in the bilateral medial medulla oblongata. He was diagnosed with BMMI, and rehabilitation treatment was initiated. On day 16, his sputum volume increased, and he could not expectorate effectively due to decreased coughing ability. Therefore, mechanical insufflation-exsufflation (MI-E) was performed to improve his airway clearance. On day 21, he developed aspiration pneumonia (AP), which became severe and led to acute respiratory failure. Nasal airway intubation and oxygen flow of 5 L/minute were initiated. His respiratory function was not seriously aggravated, and recurrent AP was prevented with the application of respiratory physiotherapy procedures, such as postural drainage, in collaboration with other medical staff, and MI-E. On day 60, the patient was transferred to the recovery phase rehabilitation ward. BMMI tends to worsen swallowing disorders progressively and is associated with a high risk of severe AP. Providing physiotherapy in the acute phase is important to reduce the risk of serious illness.
摘要：
双侧延髓内侧梗死（BMMI）是一种罕见的中风综合征，经常有不良的临床结果。关于BMMI的物理治疗的报道很少，因为其预后不良。因此,本报告旨在介绍一名发生BMMI并经过深思熟虑的康复治疗的患者.一名67岁的男子因急性呕吐和头晕出现在我们的诊所。磁共振成像（MRI）未显示异常信号强度，患者因周围性头晕入院。在第二天，他出现了四肢瘫痪,球麻痹,和呼吸损伤，例如长时间的呼吸暂停。第二次MRI显示双侧延髓内侧有高强度病变。他被诊断出患有BMMI,并开始康复治疗。在第16天，他的痰量增加，由于咳嗽能力下降，他不能有效地呕吐。因此,实施机械吹气-排气(MI-E)以改善患者的气道清除率.在第21天，他出现了吸入性肺炎（AP），变得严重并导致急性呼吸衰竭。开始鼻气道插管和5L/min的氧气流量。他的呼吸功能没有严重加重,通过应用呼吸理疗程序可以预防复发性AP，如姿势引流，与其他医务人员合作，和MI-E在第60天,患者被转移到恢复期康复病房。BMMI倾向于逐渐恶化吞咽障碍，并与严重AP的高风险相关。在急性期提供物理治疗对于降低严重疾病的风险很重要。
