순수 외측 연수경색의 특징 및 질환 중증도 관련 요인에 대한 고찰 = Characteristics of pure lateral medullary infarction and factors associated with disease severity

다국어 초록 (Multilingual Abstract)

Objectives:Lateral medullary infarction (LMI) is a representative posterior circulation stroke that can cause severe neurological deficits and prolonged hospitalization. Even among patients with pure LMI confined to the lateral medulla, clinical severity remains heterogeneous. This study aimed to characterize the clinical features of pure LMI and identify factors associated with disease severity.
Materials and Methods: We retrospectively included patients with LMI who had no other acute-phase stroke lesions within 7 days at a single center in Korea between June 2010 and May 2020. Patients were categorized by age (≤60 vs. >60 years), presence of vertebral artery disease (VAD), and hospital stay (≤7 vs. >7 days). Demographics, lesion characteristics (size and location), and major clinical symptoms were compared using univariate and multivariate analyses. The duration of hospital stay was used as a surrogate marker of disease severity, and independent predictors of prolonged hospitalization were identified with multivariate logistic regression.
Results: The mean age was 59.0 years, and 64.0% were men. VAD was observed in 102 patients (63.4%), including 19 (11.8%) with dissection. Compared with those without VAD, affected patients more often exhibited rostral–middle medullary involvement (30.4% vs. 15.3%, p=0.038), dysarthria, hoarseness, and pneumonia, with longer hospital stays (9.23 vs. 7.53 days, p=0.008). Prolonged hospitalization (>7 days) correlated with long lesions, rostral–middle involvement, VAD, vertigo, and dysphagia. In multivariate analysis, VAD (aORs 2.08, p=0.044), vertigo (aORs 3.59, p=0.005), and dysphagia (aORs 2.70, p=0.007) remained independent predictors.
Conclusion: In pure LMI, disease severity results from the combined effects of vascular pathology, anatomical extent, and functional disruption of key medullary structures. VAD is linked to more extensive rostral–middle medullary lesions and bulbar–vestibular dysfunction, which contribute to prolonged hospitalization. Early recognition and management of VAD and related dysphagia or vertigo may help prevent complications and improve outcomes.

목차 (Table of Contents)

• 서론 1
• 연구 방법 3
• 결과 9
• 고찰 13
• 참고문헌 29
• 표 37
• 그림 47