Medial medullary syndrome pdf

Although dysphagia resolves in most cases within 12 months, it may persist for months or years altogether resulting in malnutrition, dehydration and. Medial medullary syndrome mms student doctor network. Right lingual paresis was observed on tongue protrusion fig 1a. On follow up 9 months after the diagnosis and subsequent treatment, the patient showed significant improvement on all fronts. Medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal. The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. Five patients had an infarction above the pyramidal. Inferior medial pontine syndrome foville ventral pontine syndrome millard. Paramedian base contains descending motor tracts and crossing cerebellar tracts paramedian tegmentum contains oculomotor pathways. Pdf there are two major vascular syndromes of the medulla oblongata. Medial medullary infarctions mmi were reported in less than 40 patients with satisfactory clinicotopographic documentation. We studied seven patients with mriproven acute mmi seen in two neurologic departments over a 5year period 19901994. Wallenberg syndrome is a condition that affects the nervous system.

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. Furthermore, signs and symptoms of medial medullary syndrome may vary on an individual basis for each patient. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Initial brain magnetic resonance imaging mri that was done in the acute phase was. The medial medullary syndrome jama neurology jama network. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c. 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 medial medullary syndrome khangloon ho, md, kenneth r. Click on the link to view a sample search on this topic. 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 an overview sciencedirect topics. Lateral medullary syndrome an overview sciencedirect. Brainstem stroke syndromes radiology reference article. Cohen, in stroke rehabilitation fourth edition, 2016.

Ta is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of. 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. Signs and symptoms may include swallowing difficulties, dizziness, hoarseness, nausea and vomiting, nystagmus, and problems with balance. Pdf the medullary vascular syndromes revisited researchgate. Bilateral medial medullary infarction, diffusionweighted magnetic resonance imaging. A 60 year old man with hypertension and diabetes mellitus sought neurological consultation for sudden onset of numbness over the left side of body. 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. Brainstem stroke syndromes ppt linkedin slideshare. Medial medullary syndrome genetic and rare diseases. This lesion could also be due to an issue with blood delivery through the vertebral artery. Medial medullary syndrome radiology reference article. 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 previously reported 14 cases of the medial medullary. 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.

Medial pontine syndrome affects structures at the bottom of the diagram. Introduction bilateral medial medullary infarction mmi is a rare stroke syndrome and only a handful of cases. 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. The first page of the pdf of this article appears above. Ipsilateral twelfth nerve on side opposite lesion paralysis of arm and leg, sparing face. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. Wallenberg syndrome or lateral medullary infarction, is associated with the acute onset of vertigo and disequilibrium. On examination, he was conscious and had dysarthria. There was moderate dysmetria on the right and leftsided hemihypoesthesia. Medial medullary syndrome and hemiplegia cruciata hemiparesis more prominent on the lower limb and right arm paresis, positive babinski sign on the left. Medial inferior pontine syndrome is a condition associated with a contralateral hemiplegia medial pontine syndrome.

Medial medullary syndrome dejerine syndrome internet stroke. Short segment of signal loss at origin of right va, propably focal. The blood supply to the lateral medulla is the posterior inferior cerebellar artery. Lateral medullary syndrome may be complete or partial depending on the vessel. Medial medullary syndrome online neuroanatomy lecture. Begin 27 06 the lateral medullary syndrome transcription. Bilateral medial medullary syndrome presenting with heart appearance sign suryanarayana sharma p. 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. Key words cerebra l latera infarctionl medullary syndrome magnetic resonanc stroke imagine g assessment yond the dorsolateral portion were included the 33. In this case report we present a patient who developed mms secondary to takayasu arteritis ta. 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.

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. Lateral medullary syndrome wallenberg syndrome prof. What are the symptoms of the lateral medullary syndrome. 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. The medial medullary syndrome is characterized by the. 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. Wallenberg syndrome pica syndrome lateral medullary. In a 55yearold woman, the medial medullary syndrome developed owing to infarction of the left medullary pyramid, ventromedial portion of the inferior olivar. 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 syndrome and meningovascular syphilis. 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.

The most common brainstem stroke syndrome seems to be the lateral medullary syndrome wallenberg syndrome 1. The previously reported 14 cases of the medial medullary syndrome. Information on how to subscribe to neurology and neurology. Bilateral medial medullary syndrome secondary to takayasu. 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. Rare stroke syndrome medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. Rarely does it produce medial medullary infarction as observed in our.

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. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Intracranial vertebral artery occlusion more often manifests with lateral medullary syndrome. Medial medullary syndrome dejerine syndrome internet. Wallenberg s syndrome information page what research is being done. Two patients had infarction below the pyramidal decussation, with ipsilateral hemiparesis and lemniscal sensory loss. Lateral and medial medullary infarction aha journals. 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. This occurs within the medulla at the level of the olive and above the pyramidal decussation. The patient was diagnosed with recurrent ischemic stroke. Mmi represented less than 1% of ischemic strokes in the posterior circulation. Anterior spinal artery syndrome results in the occlusion of the artery at the level of the spine. Wallenberg s syndrome ws has been observed as the cause of most severe form of dysphagia among all varieties of stroke. Moderate irregular narrowing of bilateral intracranial icas, left va and ba.