背景:这项研究的目的是确定皮质球束的病程以及与延髓外侧梗死(LMI)中面部轻瘫(FP)发生相关的因素。
方法:对三甲医院确诊为LMI的患者进行回顾性调查,根据是否存在FP分为两组。FP通过House-Brackmann量表定义为II级或更高。分析两组在病变解剖部位的差异,人口统计数据(年龄,sex),危险因素(糖尿病,高血压,吸烟,先前的中风,心房颤动和其他心脏因素),磁共振血管造影术涉及大血管,其他症状和体征(感觉症状,步态共济失调,肢体共济失调,头晕,霍纳综合征,声音嘶哑,吞咽困难,构音障碍,眼球震颤,恶心/呕吐,头痛,颈部疼痛,复视和打嗝)。
结果:在44例LMI患者中,15例(34%)患者有FP,所有患者均为同病中央型FP。FP组倾向于累及延髓外侧的上部(p<0.0001)和相对腹侧(p=0.019)部分。水平大的病变也与FP的存在有关(p=0.044)。吞咽困难(p=0.001),构音障碍(p=0.003)和打嗝(p=0.034)更可能伴有FP。否则,没有显著差异。
结论:本研究的结果表明,支配下面部的皮质球根纤维在延髓的上水平处上升,并通过背外侧延髓上升,在该位置,纤维的浓度在模糊核附近最密集。
The purpose of this study was to identify course of the corticobulbar tract and factors associated with the occurrence of facial paresis (FP) in lateral medullary infarction (LMI).
Patients diagnosed with LMI who were admitted to tertiary hospital were retrospectively investigated and divided into two groups based on the presence of FP. FP was defined as grade 2 or more by the House-Brackmann scale. Differences between the two groups were analyzed with respect to anatomical location of the lesions, demographic data (age, sex), risk factors (diabetes, hypertension, smoking, prior stroke, atrial fibrillation, and other cardiac risk factors for stroke), large vessel involvement on magnetic resonance angiography, other symptoms and signs (sensory symptoms, gait ataxia, limb ataxia, dizziness, Horner syndrome, hoarseness, dysphagia, dysarthria, nystagmus, nausea/vomiting, headache, neck pain, diplopia, and hiccup).
Among 44 LMI patients, 15 patients (34%) had FP, and all of them had ipsilesional central-type FP. The FP group tended to involve upper (p < 0.0001) and relative ventral (p = 0.019) part of the lateral medulla. Horizontally large lesion was also related to the presence of FP (p = 0.044). Dysphagia (p = 0.001), dysarthria (p = 0.003), and hiccups (p = 0.034) were more likely to be accompanied by FP. Otherwise, there were no significant differences.
The results of present study indicate that the corticobulbar fibers innervating the lower face decussate at the upper level of the medulla and ascend through the dorsolateral medulla, where the concentration of the fibers is densest near the nucleus ambiguus.