2岁男童眼睑下垂伴构音障碍

Blepharoptosis and dysarthria in a boy aged 2 years

摘要:

2岁4个月男性患儿，突发右侧眼睑下垂，口角向右侧歪斜，伴饮水呛咳、眼球震颤、运动倒退。头部MRI示延髓右侧背外侧梗死后软化灶，头部CT血管造影示右侧椎动脉V4段近端部分未显影。患儿确诊为延髓背外侧综合征，给予丙种球蛋白调节免疫，甘露醇减轻神经元水肿，低分子肝素钠改善闭塞血管局部高凝，高压氧改善病灶局部缺血缺氧，促进脑功能恢复，神经肌肉电刺激促进神经肌肉功能恢复等治疗。出院前患儿仅残留轻度右侧共济失调及Horner综合征。该文首次报道了1例幼儿期延髓背外侧综合征，为该病的诊断和治疗提供了经验。

Abstract:

A boy, aged 2 years and 4 months, had a sudden onset of blepharoptosis of the right eyelid, accompanied by the mouth deviated to the right side, drinking cough, nystagmus, and developmental regression. Cranial MRI showed softening lesions formed after infarction of the right dorsolateral medulla oblongata, while head CT angiography showed no imaging of the proximal part of the V4 segment of the right vertebral artery. The child was diagnosed with dorsolateral medulla oblongata syndrome and was treated with gamma globulin to regulate immune function, with mannitol to reduce neuronal edema, with low-molecular-weight heparin sodium to improve local hypercoagulation of occluded blood vessels, with hyperbaric oxygen to improve local ischemia and hypoxia and promote the recovery of brain function, and with neuromuscular electrical stimulation to promote the recovery of neuromuscular function. Before discharge, only mild right ataxia and Horner syndrome remained. This article reports the first case of infantile dorsolateral medulla oblongata syndrome and provides experience for the diagnosis and treatment of the disease.