Vascular lesion of anterior spinal or paramedian branches of the vertebral arteries leading to infarction in the medial medulla affecting the pathways and nucleus mentioned as 4 m. The patient was diagnosed with recurrent ischemic stroke. We studied seven patients with mriproven acute mmi seen in two neurologic departments over a 5year period 19901994. Medial medullary infarctions mmi were reported in less than 40 patients with satisfactory clinicotopographic documentation. Moderate irregular narrowing of bilateral intracranial icas, left va and ba. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. Some people have uncontrollable hiccups, loss of pain and temperature sensation on one side of the face, andor weakness or numbness on one side of the body. The previously reported 14 cases of the medial medullary syndrome. Medial medullary syndrome occlusion of vertebral artery or of branch of vertebral or lower basilar artery on side of lesion paralysis with atrophy of onehalf half the tongue. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. The first page of the pdf of this article appears above.
Pdf the medullary vascular syndromes revisited researchgate. Paramedian base contains descending motor tracts and crossing cerebellar tracts paramedian tegmentum contains oculomotor pathways. This syndrome is due to malperfusion in the territory of the anteromedial group of medullary arteries arising from the vertebral or anterior spinal artery and leads to a contralateral hemiplegia pyramidal tract, b dysarthria inferior olivary nucleus, nucleus ambiguus, c decreased proprioception medial lemniscus, d nystagmus. Here, i present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. Intracranial vertebral artery occlusion more often manifests with lateral medullary syndrome. Short segment of signal loss at origin of right va, propably focal. On follow up 9 months after the diagnosis and subsequent treatment, the patient showed significant improvement on all fronts. Lateral medullary syndrome may be complete or partial depending on the vessel. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c. In a 55yearold woman, the medial medullary syndrome developed owing to infarction of the left medullary pyramid, ventromedial portion of the inferior olivary nucleus, medial lemniscus, and hypoglossal nerve. The medial medullary syndrome khangloon ho, md, kenneth r. Five patients had an infarction above the pyramidal. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. This occurs within the medulla at the level of the olive and above the pyramidal decussation.
Wallenberg syndrome pica syndrome lateral medullary. The medial medullary syndrome is characterized by the. Wallenberg s syndrome ws has been observed as the cause of most severe form of dysphagia among all varieties of stroke. Thus a medial brainstem syndrome will consist of the 4 ms and the relevant motor cranial nerve, and a lateral brainstem syndrome will consist of the 4 ss and either the 911th cranial nerve if in the medulla, or the 5th, 7th and 8th cranial nerve if in the pons. Information on how to subscribe to neurology and neurology. Begin 27 06 the lateral medullary syndrome transcription.
In this case report we present a patient who developed mms secondary to takayasu arteritis ta. Medial medullary syndrome dejerine syndrome internet. Dorsolateral medullary syndrome of wallenbergs syndrome, also known as posterior cerebellar artery syndrome or lateral medullary syndrome, is the commonest of the brain stem strokes figure 2 a,b with the middle medulla most frequently affected. Key words cerebra l latera infarctionl medullary syndrome magnetic resonanc stroke imagine g assessment yond the dorsolateral portion were included the 33. What are the symptoms of the lateral medullary syndrome. Wallenberg syndrome or lateral medullary infarction, is associated with the acute onset of vertigo and disequilibrium. Initial brain magnetic resonance imaging mri that was done in the acute phase was. Rarely does it produce medial medullary infarction as observed in our. Student doctor, what syndrome results from the occlusion of the vertebral artery or one of its medullary branches such as the posterior inferior cerebellar artery. Lateral medullary syndrome is a neurological disorder causing a range of symptoms due to ischemia in the lateral part of the medulla oblongata in the brainstem. The national institute of neurological disorders and stroke ninds conducts research related to wallenberg s syndrome in its laboratories at the national institutes of health nih, and also supports additional research through grants to major medical institutions across the. Medial medullary syndrome mms student doctor network. Mmi represented less than 1% of ischemic strokes in the posterior circulation. The most common brainstem stroke syndrome seems to be the lateral medullary syndrome wallenberg syndrome 1.
Rare stroke syndrome medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. Medial medullary syndrome online neuroanatomy lecture. Medial medullary syndrome mms is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its. About twothirds of all ischemic stroke occurs in the middle cerebral artery territory mca stroke can involve the frontal, temporal, and parietal lobes mca stroke can also involve the basal ganglia through the. The blood supply to the lateral medulla is the posterior inferior cerebellar artery. Pdf there are two major vascular syndromes of the medulla oblongata. Medial medullary syndrome and hemiplegia cruciata hemiparesis more prominent on the lower limb and right arm paresis, positive babinski sign on the left. Wallenberg syndrome is a condition that affects the nervous system.
Brainstem stroke syndromes ppt linkedin slideshare. Click on the link to view a sample search on this topic. Ta is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of. Medial medullary syndrome an overview sciencedirect topics. The most common stroke of the vestibular system, first reported in the late 19th century, 31 is lateral medullary syndrome, also known as wallenberg syndrome. Introduction bilateral medial medullary infarction mmi is a rare stroke syndrome and only a handful of cases. This lesion could also be due to an issue with blood delivery through the vertebral artery.
Medial medullary syndrome and meningovascular syphilis. Ipsilateral twelfth nerve on side opposite lesion paralysis of arm and leg, sparing face. Medial pontine syndrome affects structures at the bottom of the diagram. Medial medullary syndrome radiology reference article. Anterior spinal artery syndrome results in the occlusion of the artery at the level of the spine. A 60 year old man with hypertension and diabetes mellitus sought neurological consultation for sudden onset of numbness over the left side of body. Inferior medial pontine syndrome foville ventral pontine syndrome millard. Brainstem stroke syndromes radiology reference article. This signs and symptoms information for medial medullary syndrome has been gathered from various sources, may not be fully accurate, and may not be the full list of medial medullary syndrome signs or medial medullary syndrome symptoms. Medial medullary syndrome dejerine syndrome internet stroke.
It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Lateral and medial medullary infarction aha journals. Wallenberg s syndrome information page what research is being done. There was moderate dysmetria on the right and leftsided hemihypoesthesia. Signs and symptoms may include swallowing difficulties, dizziness, hoarseness, nausea and vomiting, nystagmus, and problems with balance. Bilateral medial medullary syndrome presenting with heart appearance sign suryanarayana sharma p. On examination, he was conscious and had dysarthria. Bilateral medial medullary syndrome secondary to takayasu. The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. Lateral medullary syndrome an overview sciencedirect. Medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal. Furthermore, signs and symptoms of medial medullary syndrome may vary on an individual basis for each patient.
Two patients had infarction below the pyramidal decussation, with ipsilateral hemiparesis and lemniscal sensory loss. Wallenberg syndrome lateral medullary syndrome aka pica syndrome posterior inferior cerebellar artery syndrome constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain. Clinical presentation each brainstem stroke syndrome has a characteristic clinical picture according to the involved area, however, generally, there is ipsilateral cranial nerve palsy and contralateral hemiplegiahemiparesis andor. Medial inferior pontine syndrome is a condition associated with a contralateral hemiplegia medial pontine syndrome. Right lingual paresis was observed on tongue protrusion fig 1a.
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