A 61 year old woman presented at the emergency ward with a 3 day history of fluctuating vertigo and lateropulsion to the right. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Medial medullary syndrome genetic and rare diseases. Recently we came across a patient with bilateral medial medullary infarction with unique and characteristic magnetic resonance imaging mri. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. Media in category lateral medullary syndrome the following 2 files are in this category, out of 2 total. We describe the acute and longterm prognosis in 43 patients with lateral medullary infarction lmi collected from a populationbased stroke registry from 1982 to july 1988. What are the symptoms of medial medullary syndrome in.
The diagnosis is made clinically and with the help of magnetic resonance imaging. Thirteen patients were followed after discharge from the hospital over a mean time of 1 year. Hemiinfarction of the medulla causes the clinical constellation of symptoms and signs of both the lateral and medial medullary syndromes and nearly always. Neal hermanowicz, in textbook of clinical neurology third edition, 2007.
Click on the link to view a sample search on this topic. Hypoglossal nuclei and nerve fibers arises from the meeting pont of pons and medulla. Spectrum of lateral medullary syndrome ahaasa journals. The medullary vascular syndromes revisited springerlink.
The clinical picture was suggestive of lateral medullary syndrome lms. Thus, if a spinal cord syndrome encompasses a certain area of the spinal cord, only the legs, hands, or chest down can be affected, for example. Medial medullary syndrome ipsilateral paralysis and atrophy of tongue ataxia of limb, nystagmus, nausea, vertigo contralateral paralysis of arm and leg spare face penetrating branch of vertebral or lower basilar artery. Medial medullary syndrome online neuroanatomy lecture. Consequently, problems with the conus medullaris often affect the cauda equina. Occlusion of these penetrating branches to one side of the medial medulla may result in a pattern of deficits characteristic of the medial medullary syndrome dejerine syndrome. Contralateral weakness or paralysis pyramidal tract contralateral numbness medial lemniscus. 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. The neurological problem was ascribed to right medial medullary infarction due to occlusion of antero. Conus medullaris syndrome is a secondary form of spinal cord damage resulting from injuries to the lumber.
Lateral medullary syndrome, also known as wallenbergs syndrome, is an ischemic disease of the medulla which involves the territory of the posterior inferior cerebellar artery 1. Lateral medullary syndrome is also called wallenbergs syndrome, posterior inferior cerebellar artery pica. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. The medial medullary syndrome is characterized by the triad of. The symptoms that constitute the lateral medullary syndrome are well established. Each part of the spinal cord corresponds to a function and place of the body. The functional outcome and degree of disability of patients with lmi, however, have not been as well investigated. There are two major vascular syndromes of the medulla oblongata. The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. Medial medullary syndrome symptoms, diagnosis, treatments. Pdf there are two major vascular syndromes of the medulla oblongata. Then again clinical bed side swallow evaluation was done on the 3rd day of admission and the results reveal poor cough effort, weak gag reflex, fair lingual strength, wetness in throat, frequent throat clearing and poor oral coordination and mastication and. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree.
Pdf the medullary vascular syndromes revisited researchgate. If you have problems viewing pdf files, download the latest version of adobe reader. Intracranial vertebral artery occlusion more often manifests with lateral medullary syndrome. Rarely, patients may manifest the following symptoms of a medial medullary syndrome. The knowledge of brain syndromes is essential for stroke physicians and neurologists, particularly those that can be extremely difficult and challenging to diagnose due to the great variability of. Recovery pattern of dysphagia in lateral medullary. Lateral medullary syndrome is a specific type of stroke that occurs in the brain stem. It is located in between median fissure and ventrolateral sulcus.
Bilateral medial medullary infarction mmi is a rare stroke subtype. Wallenberg syndrome editor may 15, 2011 20110515t18. Medial medullary syndrome, also known as dejerine syndrome, is secondary to thrombotic or embolic occlusion of small perforating branches from vertebral or proximal basilar artery supplying the medial aspect of medulla oblongata 1,2. Less than 1% of all posterior circulation infarctions present as medial medullary syndrome, bilateral being even rarer 1, 2. 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. This results in the infarction of medial part of the medulla oblongata. Medial medullary syndrome due to vertebral artery dissection. Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal. The conus medullaris is the bundled, tapered end of the spinal cord nerves. Ischemia of brain tissue and the tracts passing through the medulla manifest with various symptoms, most commonly ataxia, nystagmus, voice changes, dysphagia and sensory deficits. Situated near the first two lumbar vertebrae, the conus medullaris ends at the cauda equina, a bundle of spinal nerves and nerve roots. Most commonly occlusion is intracranial portion of the vertebral artery or posterior inferior cerebellar artery pica andor its branches. Lateral medullary syndrome anterior or posterior circulation stroke. 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.
Ross et al3 found mriidentified lesions in their 4 patients with lateral medullary syndrome lms, and bogousslavsky et. I describe a patient in whom the syndrome was caused by metastatic oat cell carcinoma. Moderate irregular narrowing of bilateral intracranial icas, left va and ba. The lateral medullary syndrome is not a very common stroke. Lateral medullary syndrome also called wallenberg syndrome and posterior inferior cerebellar artery syndrome is a disorder in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis. A rare condition caused by a blood clot or other trauma in the brainstem. Medial medullary syndrome an overview sciencedirect topics. The topography of the lesion and the absence of flow in the right vertebral artery favoured infarction over demyelination as the likely aetiology. The lateral medullary syndrome, also known as wallenbergs syndrome, is the prototype lesion involving the nuclei of cranial nerves ix and x. Ibrahim mollah, 50 years old male person, non diabetic, non hypertensive but smoker presented with. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. Bilateral medial medullary infarction with distal stenosis o. Cause of medial medullary djerines syndrome 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 syndrome results from infarction of the medulla by vertebral artery thrombosis or dissection that may also produce occlusion of the opening to the posterior.
Lateral medullary syndrome wallenberg syndrome is an acute ischemic infarct due to occlusion of the vessels supplying the lateral medulla oblongata. The branches of the anterior spinal artery that penetrate into medial portions of the medulla tend to alternate to the right and left. Our patient presented with the classical clinical triad of dejerines syndrome, that includes ipsilateral hypoglossal palsy, contralateral haemiparesis, and lemniscal sensory loss. The resulting symptoms affect the side of the body opposite to the site of the lesion. It usually leads to quadriplegia, sensory disturbance. These videos are designed for medical students studying for the usmle step 1. The medial medullary syndrome jama neurology jama network. Wallenberg syndrome pica syndrome lateral medullary. Recovery following lateral medullary infarction neurology.
Lateral medullary infarction lmi has a welldefined clinical syndrome and vascular pathology. We followed 18 consecutive patients with lmi during inpatient stroke rehabilitation. What links here related changes upload file special pages permanent link page. The previously reported 14 cases of the medial medullary.
Medial medullary syndrome radiology reference article. More detailed information about the symptoms, causes, and treatments of medial medullary syndrome is available below. Rarely does it produce medial medullary infarction as observed in our. The medial medullary syndrome khangloon ho, md, kenneth r. Short segment of signal loss at origin of right va, propably focal stenosis medial medullar syndrome of. Lateral medullary syndrome causing vocal cord palsy and stridor j nicholson, u paralkar, g lawton, p sigston we report a 63yearold patient with lateral medullary syndrome secondary to a medullary haemorrhage, causing unilateral vocal cord palsy which precipitated respiratory failure sufficient to warrant intubation and ventilation. In addition, slight motor weakness, decreased joint position, and vibration. 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. The lateral medullary syndrome was described in 1808 by. For language access assistance, contact the ncats public information officer. Meyer, md \sb\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. Clinical examination showed slurred speech, conjugated right beating horizontal nystagmus in primary gaze that increased on gaze to the right, and a right sided tongue paresis figure a.
It is sometimes called posterior inferior cerebellar artery syndrome because the condition involves a blood vessel instrumental in supplying blood to the brain. This lesion could also be due to an issue with blood delivery through the vertebral artery. Medial and lateral medullary syndrome see online here brain stem syndromes are characterized by in. Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal alternating hemiplegia, lower alternating hemiplegia, or dejerine syndrome, is a type of alternating hemiplegia characterized by a set of clinical features resulting from occlusion of the anterior spinal artery. In a 55yearold woman, the medial medullary syndrome developed owing to infarction of the left medullary pyramid, ventromedial portion of the inferior olivar. Lateral medullary syndrome an overview sciencedirect. The medullary syndromes can occur at any level of the spinal cord, producing symptoms from the damaged area down. This occurs within the medulla at the level of the olive and above the pyramidal decussation. Now, let us move onto the discussion of medial medullary syndrome djerines syndrome.
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