Research Project code：0450021006
Update date：Dec. 15, 2003
Neurological symptomatology: Neurological manifetstations in 93 cases with medullary infarction
2002 - 0
Investigating Researcher (1)：
Neurological symptoms of 93 cases of medullary infarction hospitalized in 1988-2002 were analyzed. Classification by clinical symptoms showed 36 cases of apparent medullar frontal inner side symptoms (Dejerine symptoms) such as opposite side hemiplegia other than face, disturbance of opposite deep sense and ipsilateral hypoglossal nerve paralysis with average age of 69.6 and 52 cases of medullar outer side symptoms with average age of 62.6, indicating more advanced ages in the former group. Medullary infarctions accompanied with the other symptoms included five cases of average years of 62. Prior to the introduction of MRI, no lesion of medullar frontal inner side was detected and only medullar outer side lesion was detected by image diagnosis with CT. However, on and after 1996, each 35 cases of medullar frontal inner side symptoms and medullar outer side symptoms, respectively, were found. Male patients were by far dominant as well as the preceding studies and 83.3% of medullar frontal inner side symptoms and 86.5% of medullar outer side symptoms were found in male patients. MRA was performed to 91 cases and cerebral angiography was done to 1 case. A relationship between occlusive blood vessel lesions and clinical symptoms showed 9 cases of ipsilateral occlusion of vertebral artery, 6 cases of ipsilateral stenosis of vertebral artery, 3 cases of bilateral occlusion of vertebral arteries, 3 cases of bilateral stenosis of vertebral arteries and 5 cases of no occlusive lesion. While medullar outer side symptoms showed 15 cases of ipsilateral occlusion of vertebral artery, 8 cases of ipsilateral occlusion of posterior inferior cerebral artery, 7 cases of ipsilateral stenosis of vertebral artery, 2 cases of bilateral stenosis of vertebral artery and 7 cases of no occlusive lesion. Risk factors of hypertension and hyperlipidemia were found about 70% and about 40%, respectively, in both groups without difference. Cases of diabetes mellitus were found in medullar frontal inner side syndrome at 54.5%, however, a little lower at 36.7% in medullar outer side symptoms. Complication with atrial fibrillation was found at 18.2% in medullar frontal inner side symptoms and 11.1% in medullar outer side symptoms. Other risk factors showed no marked differences between two groups. 52 cases of medullar outer side symptoms included 82.1% of body dystonia, 62.9% of ipsilateral motor ataxia, 73.9% of hoarse voice, 48.5% of articulation disorder and 52.1% of swallowing disorder. In medullar inner side syndrome, only 8% of patients had all three symptoms of opposite side hemiplegia other than face, disturbance of opposite deep sense and ipsilateral hypoglossal nerve paralysis. Quadriplegia and death rate were reported in 23-43% and 10-15% of cases, respectively, in literatures, however, the former cases were found in only 5.6% and no dead case was found in the present study indicating a number of mild cases in the present study. This may be the results of frequent detection of mild cases by detailed neuroradiological diagnosis with thorough use of MRI.
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