Medial medullary syndrome radiology reference article. A condition in which deep sensation is depressed but tactile sense is normal, caused by a lesion of the long root fibers of the posterior spinal column. Medial medullary syndrome due to vertebral artery dissection. Deposits of talc, presumably from a medication prepared for oral use, were demonstrated in the small vessels in the area of the medullary infarction. Lateral medullary syndrome online neuroanatomy lecture. Five patients had an infarction above the pyramidal. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Inferior medial pontine syndrome foville ventral pontine syndrome. Weakness, sensory loss in arm and leg nausea, nystagmus, dysphagia, dysarthria medullary infarct on diffusionweighted imaging. 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 branches. Medial medullary infarction is less common than lateral medullary infarction and involves both medullary. On follow up 9 months after the diagnosis and subsequent treatment, the patient showed significant improvement on all fronts. Jun 29, 2012 the most common mechanism of medial medullary infarction in a recent study was smallvessel occlusion, 20 which is consistent with our findings.
Hemimedullary syndrome, also known as reinhold syndrome, occurs as a result of the occlusion of the ipsilateral vertebral artery proximal to the posterior inferior cerebellar artery and its anterior spinal artery branches. This pointed tip of the medullary pyramid is known as the papilla. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. The rainforest hermit who stepped out of the wild australian story. This results in the infarction of medial part of the medulla oblongata. Introduction bilateral medial medullary infarction mmi is a rare stroke syndrome and only a handful of cases. In this case report we present a patient who developed mms secondary to takayasu arteritis ta. This lesion could also be due to an issue with blood delivery through the vertebral artery. The most common cause is a lateral medullary infarction, which produces a horner syndrome as part of the wallenberg syndrome. We studied seven patients with mriproven acute mmi seen in two neurologic departments over a 5year period 19901994.
In this article, we emphasize on clinical characteristics of medial medullary syndrome and lateral medullary syndrome in perspective of the topographical organization of medulla. Medial medullary dejerine syndrome contralateral hemiparesis pyramidal tract contralateral loss of light touch, vibration. There is a list of classical stroke syndromes arranged by arterial terriotry, which one needs to commit to memory. 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.
Medial superior pontine syndrome paramedian branches of upper basilar artery on side of lesion cerebellar ataxia probably. Superior andor middle cerebellar peduncle internuclear ophthalmoplegia. Mechanism of medullary infarction based on arterial territory. Information on how to subscribe to neurology and neurology. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. Medial medullary stroke due to neurosyphilis in a newly. It is estimated that there are around 600,000 new cases of this syndrome in the united states alone. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. Bilateral medial medullary infarction, diffusionweighted magnetic resonance imaging. Hemiinfarction of the medulla causes the clinical constellation of symptoms and signs of both the lateral and medial medullary syndromes and nearly always results from occlusion of an intracranial vertebral artery.
This list includes dominant and nondominant mca infarction, medial and lateral medullary syndromes, anterior and posterior cerebral artery syndromes and the basilar artery syndrome. Wallenberg syndrome or lateral medullary infarction, is associated with the acute onset of vertigo and disequilibrium. Five patients had an infarction above the pyramidal decussation. 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.
In the case reported here, with a clinical diagnosis of hemimedullary syndrome, the expected infarction was imaged by magnetic resonance. Subsequent angiographic identification of abnormal arteries implicated a vascular malformation as the cause. Central facial weakness due to medial medullary infarction. The medullary vascular syndromes revisited springerlink. This case is unique in that the medial medullary syndrome was apparently caused by an embolus of talc following its iv administration. Dejerine syndrome definition of dejerine syndrome by. The medial medullary syndrome jama neurology jama network. 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. Wallenberg syndrome pica syndrome lateral medullary. Medial medullary infarctions mmi were reported in less than 40 patients with satisfactory clinicotopographic documentation.
Mar 16, 20 medial superior pontine syndrome paramedian branches of upper basilar artery on side of lesion cerebellar ataxia probably. Brainstem stroke syndromes ppt linkedin slideshare. Medial medullary infarction caused by antineutrophil cytopla. Hemimedullary syndrome radiology reference article. Lateral medullary infarction commonly presents with homers syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and. Short segment of signal loss at origin of right va, propably focal stenosis medial medullar syndrome of. Lateral medullary syndrome wallenberg syndrome prof. Mar 12, 20 stroke syndromes and clinical management. Wallenberg syndrome abstract cerebrovascular disease is a clinical syndrome characterized by the rapid development of focal neurological signs that persist for more than 24 hours without apparent cause other than vascular origin. Some people have uncontrollable hiccups, loss of pain and temperature sensation on one side of the face, andor weakness or numbness on one. Medial medullary syndrome online neuroanatomy lecture.
Mmi represented less than 1% of ischemic strokes in the posterior circulation. Our patient presented with the classical clinical triad of dejerines syndrome, that includes ipsilateral hypoglossal palsy, contralateral haemiparesis, and lemniscal sensory loss. Medial medullary syndrome and meningovascular syphilis. What are the symptoms of the lateral medullary syndrome. On examination, he was conscious and had dysarthria. Yuichiro yoneoka, ryo ikeda, naotaka aizawa, yasuhiro seki, katsuhiko akiyama, medial pontomedullary junctional infarction presenting vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia and dysphagia without lateral gaze palsy, curtain sign and hoarseness. Bilateral medial medullary syndrome secondary to takayasu. May 22, 2017 wallenberg syndrome is a condition that affects the nervous system. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c.
Furthermore, signs and symptoms of medial medullary syndrome may vary on an individual basis for each patient. 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. Medial medullary syndrome an overview sciencedirect topics. Medial medullary syndrome and meningovascular syphilis a case report in an htv. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. Lateral medullary syndrome radiology reference article. Lateral medullary syndrome is also called wallenberg s syndrome, posterior inferior cerebellar artery pica. The previously reported 14 cases of the medial medullary syndrome. Here we report a case of medullary hemorrhage diagnosed by mri in which the patient presented with a mixed lateral and medial medullary syndrome. Now, let us move onto the discussion of medial medullary syndrome djerines syndrome. Medial meduller sendrom medullay etkileyen iki temel. Initial brain magnetic resonance imaging mri that was done in the acute phase was. Medial pontomedullary junctional infarction presenting. Here, i present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome.
Medial medullary infarction mmi syndrome was initially described by spiller more than 100 years ago, 1 and dejerine proposed a triad of symptoms. Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal alternating hemiplegia, lower alternating hemiplegia, 1 or dejerine syndrome, 2 is a type of alternating hemiplegia characterized by a set of clinical features resulting from occlusion of the anterior spinal artery. Background and purpose clinicalimaging correlation and longterm clinical outcomes remain to be investigated in medial medullary infarction mmi. Typically, the patient presents with vertigo and ataxia. Medial medullary syndrome aka dejerine syndrome is a rare condition that develops following infarction of the medial medulla and is classically defined by the presence of dejerines triad of contralateral weakness in upper and lower extremities, contralateral hemisensory loss of vibration and proprioception, and ipsilateral tongue weakness. In many texts hemimedullary syndrome is incorrectly used as. Wallenberg syndrome or lateral medullary infarction, is associated with. A 61 year old woman presented at the emergency ward with a 3 day history of fluctuating vertigo and lateropulsion to the right. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. Distributing copies electronic or otherwise of the article is. There was moderate dysmetria on the right and leftsided hemihypoesthesia. Pdf medial medullary syndrome due to vertebral artery. Right lingual paresis was observed on tongue protrusion fig 1a. This is the result of a vascular lesion that involves either the vertebral artery andor the posterior inferior cerebellar artery which is known by its acronym, pica.
Jun 19, 2017 cerebellar medullary compression syndrome. Wallenberg syndrome is a condition that affects the nervous system. Medial longitudinal fasciculus myoclonic syndrome, of palate, pharynx, vocal cords, respiratory apparatus, face, oculomotor apparatus. Lateral medullary syndrome, also known as wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata. Data from these patients support the hypothesis that part of the corticobulbar fibres supplying the lower facial muscles descend ipsilaterally in the ventromedial part of the upper medulla and then, after decussation. This occurs within the medulla at the level of the olive and above the pyramidal decussation. This is most commonly due to occlusion of the intracranial portion of the vertebral artery followed by pica and its branches. Methods we studied clinical, mri, and angiographic data of 86 consecutive mmi patients. 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. The other neurological findings included left lemniscal sensory impairment and mild left haemiparesis without. Ta is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of. 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 and hemiplegia cruciata hemiparesis more prominent on the lower limb and right arm paresis, positive babinski sign on the left. A 60 year old man with hypertension and diabetes mellitus sought neurological consultation for sudden onset of numbness over the left side of body.
Rare case of atypical dejerine syndrome in a child journal. Medial medullary syndrome results from an occlusion of a vertebral artery or the anterior spinal artery. Medial medullary syndrome definition of medial medullary. Two patients are reported with contralateral hemiparesis including a face of supranuclear type, caused by an infarct of the unilateral ventromedial part of the upper medulla. Lacune typically account for 2025% of stroke patients. 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. Signs and symptoms may include swallowing difficulties, dizziness, hoarseness, nausea and vomiting, nystagmus, and problems with balance. There are two major vascular syndromes of the medulla oblongata. The view that we have here is the medulla at the level of the olive. The internet stroke centre has an excellent summary of stroke syndromes. Wallenberg syndrome genetic and rare diseases information. Medullary pyramid an overview sciencedirect topics.
Click on the link to view a sample search on this topic. The risk factors for medial medullary syndrome mms and lateral medullary syndrome lms include hypertension seen in 64%89% of mms patients and 75% of lms patients, respectively, diabetes 25%27% and 37%, respectively, recent smoking history 6. 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. 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 oblongata1,2. 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. Medial medullary syndrome in a drug abuser jama neurology. Lateral medullary syndrome may be complete or partial depending on the vessel and the subsequent vascular territory involved. In addition, slight motor weakness, decreased joint position, and vibration.
The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. The lateral medullary syndrome is the most common form of posterior ischemic stroke syndrome. Medial medullary syndrome genetic and rare diseases. Medial medullary syndrome dejerine syndrome internet. Anterior spinal artery syndrome vz medial medullary duration. The lesions were correlated with clinical findings, and longterm outcomes, divided into mild and severe modified rankin scale 3, were assessed by. Mar 23, 2017 lateral medullary syndrome wallenberg syndrome 1. Hemimedullary syndrome is a rare syndrome in which both medial and lateral medullary lesions occur together with few reported cases. The payee may view, download, andor print the article for hisher personal, scholarly, research, and educational use. Moderate irregular narrowing of bilateral intracranial icas, left va and ba. 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. If you have problems viewing pdf files, download the latest version of adobe reader.
Tongue weakness sensory loss in face horners syndrome ataxia palate weakness dysphagia contralateral signs. Begin 27 06 the lateral medullary syndrome transcription. This situation causes lateral medullary infarct and medial medullary infarct simultaneously terminology. The patient was diagnosed with recurrent ischemic stroke. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences.
512 1236 822 227 176 956 359 946 201 440 489 1014 139 347 568 619 767 621 1025 990 422 289 1142 99 1375 1019 527 689 445 1220 534 872 161 290 1081