Medullary hemorrhage

Introduction Primary medullary hemorrhage (PMH) is rare in clinical practice. The posterior cranial nerve motor palsy, cerebellum sign, and conduction bundle sign are the main manifestations. Clinically misdiagnosed. Most of the primary medullary hemorrhage (PMH) is due to arteriovenous malformations or cavernous hemangioma. Primary medullary hemorrhage generally adopts conservative medical treatment. Early dehydration and reduction of intracranial pressure and reduction of cerebral edema are the key to treating medullary hemorrhage.

Cause

Causes of medullary hemorrhage

Most of the primary medullary hemorrhage (PMH) is due to arteriovenous malformations or cavernous hemangioma. There are 3 cases of diseases that have been studied in medicine, and 3 cases are young women. Among them, there are multiple hemangiomas in the liver, so it is considered to be related to congenital angiogenesis abnormalities, and there are reports of hypertensive PMH.

an examination

Related inspection

Brain CT examination of nervous system examination

Examination of medullary hemorrhage

PMH has the following characteristics:

1 There are 3 groups of symptoms of small amount of bleeding and consciousness: the posterior group of cranial nerve motor neuron damage such as cough, dysarthria, tongue and so on; conduction beam sign such as one or both limbs, shallow sensation, cone Body bundle sign, etc.; cerebellar sign such as limb ataxia, nystagmus, etc.;

2 may be associated with nerve root symptoms such as neck pain, etc., some have forced head position, considered by nerve root ischemia or stimulation;

3 The onset is not immediately reaching the peak, but there is a progress period, and the progress period can reach several days;

4 The larger amount of bleeding can suddenly coma, bilateral pyramidal tract signs, respiratory rhythm changes, etc., and more rapid death.

Differential diagnosis

Congestive symptoms of medullary hemorrhage

The disease is easily missed or misdiagnosed. Older people are easily misdiagnosed as vertebrobasilar insufficiency or inferior cerebellar infarction. There are 1 reasons for the lack of understanding of PMH, because the medulla oblongata itself is not a common site of bleeding; 2 the examination means is limited, the general CT is due to the artifact of the skull base, and the bleeding is less likely to be missed or misdiagnosed; 3 bleeding The large amount of people have died due to the destruction of the respiratory and cardiovascular centers, and the condition is dangerous. We believe that misdiagnosis or missed diagnosis of PMH is also an important reason for its low incidence. Because MRI is not interfered by bone artifacts, it can accurately display the location, size, extent and accompanying changes of hematoma, so it is a reliable means to diagnose PMH. Due to the small volume of the medulla oblongata and the presence of respiratory and cardiovascular centers, it is traditionally considered that the condition of PMH is dangerous and the prognosis is extremely poor. With the wide application of MRI, the light PMH can be diagnosed early and treated in time to recover.

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