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. 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. Corticobulbar and corticospinal tract variable impaired touch and proprioception when lesion extends. With early identification and treatment, including early swallowing evaluations, the. Recently we came across a patient with bilateral medial medullary infarction with unique and characteristic magnetic resonance imaging mri. Cortical blindness anton syndome inferior medial pontine syndrome. Medial medullary syndrome genetic and rare diseases. Cauda equina syndrome anterior spinal artery syndrome brainstem medulla cn 8, 9, 10, 12 lateral medullary syndrome wallenberg pica medial medullary syndrome dejerine asa en. Pdf there are two major vascular syndromes of the medulla oblongata. Sensory deficits affecting the trunk torso and extremities on the opposite side of the infarction. Medial medullary syndrome an overview sciencedirect topics. 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 infarction from fibrocartilaginous embolism to the anterior spinal artery. Medial medullary syndrome dejerine syndrome motor symptoms pyramidal tract contraletral hemiparesis up to 50% facial weakness contraletral sensory symptoms medial lemniscus paresthesias most often no clinical signs proprioception vibration rarely may be lost in the contraletral foot 12th nerve paralysis least common. Rare stroke syndrome medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. This is part of the spectrum of medial medullary syndrome due to occlusion of the anterior spinal artery at the time of vertebral artery occlusion. Mar 03, 2020 medial medullary dejerine syndrome this syndrome is an uncommon lesion resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery. Acute medullary pyramidal infarction radiology case.
Medial medullary dejerine syndrome this syndrome is an uncommon lesion resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery. There are two major vascular syndromes of the medulla oblongata. Medullary pyramid an overview sciencedirect topics. Wallenberg syndrome pica syndrome lateral medullary. Pdf a case of lateral medullary infarction with cardiovascular. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. Posterior to the pyramids in the midline is the medial. Han, md background and purposeclinicalimaging correlation and longterm clinical outcomes remain to be investigated in medial medullary infarction mmi. Wallenberg syndrome is a condition that affects the nervous system. Treatment aims at reducing the size of infarction and preventing any. Medial medullary infarction clinical, imaging, and outcome study in 86 consecutive patients jong s. Wallenbergs syndrome information page national institute.
This is most commonly due to occlusion of the intracranial portion of the vertebral artery followed by pica and its branches. Magnetic resonance imaging of medial medullary infarction. Mmi represented less than 1% of ischemic strokes in the posterior circulation. Wallenbergs syndrome, also called lateral medullary syndrome or wallenberg syndrome, is a neurological condition that can develop when damage occurs in a. Lateral medullary infarction commonly presents with homers syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and. Medial midpontine syndrome paramedian branch of midbasilar artery on side of lesion ataxia of limbs and gait more prominent in bilateral involvement. Initial brain magnetic resonance imaging mri that was done in the acute phase was. The main blood supply is from the two vertebral arteries, joining at the. Wallenberg syndrome genetic and rare diseases information. 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. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery.
History a 54yearold black male presented emergently to the office with an acute headache and diplopia that had persisted for two days. The medullary vascular syndromes revisited springerlink. Mechanism of medullary infarction based on arterial territory. Medial medullary syndrome is a rare form of the brainstem syndromes that has a triad including ipsilateral weakness of the tongue, contralateral hemiparesis sparing the face, contralateral loss of.
The previously reported 14 cases of the medial medullary syndrome. The first page of the pdf of this article appears above. Many have advocated the term medial tibial stress syndrome to refer to anterior shin pain as a result of exercise. Jun 19, 2017 cerebellar medullary compression syndrome. May 22, 2017 wallenberg syndrome is a condition that affects the nervous system. Multiple cranial nerve lesions neurosurgery resident. 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. A 60 year old man with hypertension and diabetes mellitus sought neurological consultation for sudden onset of numbness over the left side of body. 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. Less than 1% of all posterior circulation infarctions present as medial medullary syndrome, bilateral being even rarer 1, 2. Vertebral artery dissection presented as lateral medullary syndrome in a patient with migraine.
Wallenberg syndrome is also known as lateral medullary syndrome or the posterior. Now, let us move onto the discussion of medial medullary syndrome djerines syndrome. Hypoglossal nuclei and nerve fibers arises from the meeting pont of pons and medulla. The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. 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. This lesion could also be due to an issue with blood delivery through the vertebral artery. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. Tongue weakness sensory loss in face horners syndrome ataxia palate weakness dysphagia contralateral signs. Here, i present a young patient with acute vertigo, progressive.
The medial medullary syndrome jama neurology jama network. Prior to joining together at the midline to form the basilar artery, both the left and right. Wallenberg syndrome is also known as lateral medullary syndrome or the. Medial medullary syndrome results from an occlusion of a vertebral artery or the anterior spinal artery.
Manual muscle testing showed that the strength in her left limbs. Lateral medullary syndrome lms, also called wallenberg. Ta is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of. Medial inferior pontine syndrome is a condition associated with a contralateral hemiplegia medial pontine syndrome. Lateral medullary syndrome is also called wallenbergs syndrome, posterior inferior cerebellar artery pica.
The main blood supply is from the two vertebral arteries, joining at the pontomedullary. Spectrum of lateral medullary syndrome ahaasa journals. Brat md, phd, in practical surgical neuropathology. Medial medullary syndrome radiology reference article. 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. This list includes dominant and nondominant mca infarction, medial and lateral medullary syndromes, anterior and posterior cerebral artery syndromes and the basilar artery syndrome. Mechanism of medullary infarction based on arterial. Key words cerebra l latera infarctionl medullary syndrome magnetic resonanc stroke imagine g assessment yond the dorsolateral portion were included the 33. The medial medullary syndrome is a result of blockage of the anterior spinal artery or. This situation causes lateral medullary infarct and medial medullary infarct simultaneously terminology.
Lateral medullary syndrome may be complete or partial depending on the vessel and the subsequent vascular territory involved. Begin 27 06 the lateral medullary syndrome transcription. The previously reported 14 cases of the medial medullary. Webers syndrome, also known as superior alternating hemiplegia, is a form of stroke characterized by the presence of an ipsilateral oculomotor nerve palsy and contralateral hemiparesis or hemiplegia. Bilateral medial medullary syndrome secondary to takayasu. Moderate irregular narrowing of bilateral intracranial icas, left va and ba. Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal alternating hemiplegia, lower alternating hemiplegia, or dejerine. The medial medullary syndrome khangloon ho, md, kenneth r.
In this case report we present a patient who developed mms secondary to takayasu arteritis ta. Here, i present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. The internet stroke centre has an excellent summary of stroke syndromes. 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. This occurs within the medulla at the level of the olive and above the pyramidal decussation. Bilateral medial medullary syndrome presenting with heart appearance sign suryanarayana sharma p. Active exercises to strengthen swallowing musculature. Lateral medullary syndrome wallenberg syndrome ataxic hemiparesis. Pdf a case of lateral medullary infarction with cardiovascular autonomic dysfunction presenting as orthostatic hypotension with presyncope. Hemimedullary syndrome radiology reference article. Medial medullary syndrome definition of medial medullary. Jun 12, 2017 medial medullary syndrome the medial part of the medulla oblongata is supplied by the vertebral artery. Anterior in the medulla are the paired medullary pyramids, which carry corticospinal tracts to their decussation at the medullary spinal junction, then continue as the lateral corticospinal tracts in the spinal cord.
Thrombosis of the medullary branch produces the following signs and symptoms. Lateral medullary syndrome an overview sciencedirect topics. Lateral medullary syndrome, also known as wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata. Mar 16, 20 medial midpontine syndrome paramedian branch of midbasilar artery on side of lesion ataxia of limbs and gait more prominent in bilateral involvement. Medial medullary syndrome dejerine syndrome internet. Right lingual paresis was observed on tongue protrusion fig 1a. 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. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c. Dejerine syndrome definition of dejerine syndrome by. Weakness, sensory loss in arm and leg nausea, nystagmus, dysphagia, dysarthria medullary infarct on diffusionweighted imaging. Information on how to subscribe to neurology and neurology. Medial medullary syndrome and meningovascular syphilis. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. Lateral medullary syndrome radiology reference article.
As a result, treatment of wallenberg syndrome varies depending on the. 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. Mar 27, 2019 the national institute of neurological disorders and stroke ninds conducts research related to wallenbergs syndrome in its laboratories at the national institutes of health nih, and also supports additional research through grants to major medical institutions across the country. Paramedian base contains descending motor tracts and crossing cerebellar tracts paramedian tegmentum contains oculomotor pathways. In addition, slight motor weakness, decreased joint position, and vibration.
This results in the infarction of medial part of the medulla oblongata. The most common cause is a lateral medullary infarction, which produces a horner syndrome as part of the wallenberg syndrome. 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. There is a list of classical stroke syndromes arranged by arterial terriotry, which one needs to commit to memory. Lateral medullary infarction commonly presents with homers syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. They enter the skull through the foremen magnum and merge to form the. Lacune typically account for 2025% of stroke patients. Pontine nuclei on side opposite lesion paralysis of face, arm, and leg. 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.
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. Wallenberg syndrome is a rare condition in which an infarction, or stroke, occurs in the lateral medulla. In many texts hemimedullary syndrome is incorrectly used as. 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 pontine syndrome affects structures at the bottom of the diagram. Thalamic pain syndrome dejerineroussy syndrome weber syndrome weber syndrome anterior inferior cerebellar artery. The other neurological findings included left lemniscal sensory impairment and mild left haemiparesis without. 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. The anterior spinal artery syndrome was first described by spiller 1 in a case of thrombosis of this artery. Medial medullary infarction is characterized by ipsilateral hypoglossal nerve palsy, contralat eral hemiparesis. Our patient presented with the classical clinical triad of dejerines syndrome, that includes ipsilateral hypoglossal palsy, contralateral haemiparesis, and lemniscal sensory loss. A 61 year old woman presented at the emergency ward with a 3 day history of fluctuating vertigo and lateropulsion to the right. Typically, the patient presents with vertigo and ataxia.
Five patients had an infarction above the pyramidal. Inferior medial pontine syndrome foville ventral pontine syndrome. Click on the link to view a sample search on this topic. Medial medullary syndrome due to vertebral artery dissection. The most common mechanism of medial medullary infarction in a recent study was smallvessel occlusion, 20 which is consistent with our findings. Clinical, imaging, and outcome study in 86 consecutive.
Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. In the case reported here, with a clinical diagnosis of hemimedullary syndrome, the expected infarction was imaged by magnetic resonance. In this article, we emphasize on clinical characteristics of medial medullary syndrome and lateral medullary syndrome in perspective of the topographical organization of medulla. Furthermore, signs and symptoms of medial medullary syndrome may vary on an individual basis for each patient. The medial medullary syndrome is characterized by the. Short segment of signal loss at origin of right va, propably focal stenosis medial medullar syndrome of. 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.
Hemimedullary syndrome is a rare syndrome in which both medial and lateral medullary lesions occur together with few reported cases. It is caused by midbrain infarction as a result of occlusion of the paramedian branches of the posterior cerebral artery or of basilar bifurcation perforating arteries. 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. 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. The diagnosis usually is made on the basis of clinical findings because the cause of the. 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. Wallenbergs syndrome, also called lateral medullary syndrome or wallenberg syndrome, is a neurological condition that can develop when damage occurs in a part of the brainstem called the lateral. Signs and symptoms may include swallowing difficulties, dizziness, hoarseness, nausea and vomiting, nystagmus, and problems with balance. Inferior medial pontine syndrome foville ventral pontine syndrome millard.