Hypoglossal nuclei and nerve fibers arises from the meeting pont of pons and medulla. Medial medullary syndrome definition of medial medullary. Largeartery atherosclerosis produced lesions in the lateral, anteromedial, and posterior territories. Medial medullary syndrome and meningovascular syphilis. Medial inferior pontine syndrome is a condition associated with a contralateral hemiplegia medial pontine syndrome. Wallenbergs syndrome, also called lateral medullary syndrome or wallenberg syndrome, is a neurological condition that can develop when damage occurs in a. This list includes dominant and nondominant mca infarction, medial and lateral medullary syndromes, anterior and posterior cerebral artery syndromes and the basilar artery syndrome. 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. Vertebral artery dissection presented as lateral medullary syndrome in a patient with migraine. Acute medullary pyramidal infarction radiology case. In the case reported here, with a clinical diagnosis of hemimedullary syndrome, the expected infarction was imaged by magnetic resonance.
Brat md, phd, in practical surgical neuropathology. A 61 year old woman presented at the emergency ward with a 3 day history of fluctuating vertigo and lateropulsion to the right. 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. Lateral medullary infarction commonly presents with homers syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and. We studied seven patients with mriproven acute mmi seen in two neurologic departments over a 5year period 19901994. Our patient presented with the classical clinical triad of dejerines syndrome, that includes ipsilateral hypoglossal palsy, contralateral haemiparesis, and lemniscal sensory loss. Initial brain magnetic resonance imaging mri that was done in the acute phase was. 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. Lateral medullary syndrome lms, also called wallenberg. 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. Cortical blindness anton syndome inferior medial pontine syndrome. Lateral medullary syndrome an overview sciencedirect topics.
Mechanism of medullary infarction based on arterial territory. Here, i present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome. In this article, we emphasize on clinical characteristics of medial medullary syndrome and lateral medullary syndrome in perspective of the topographical organization of medulla. Pdf a case of lateral medullary infarction with cardiovascular. Sensory deficits affecting the trunk torso and extremities on the opposite side of the infarction. Information on how to subscribe to neurology and neurology. 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. The first page of the pdf of this article appears above. The medullary vascular syndromes revisited springerlink.
Many have advocated the term medial tibial stress syndrome to refer to anterior shin pain as a result of exercise. Recently we came across a patient with bilateral medial medullary infarction with unique and characteristic magnetic resonance imaging mri. Medial medullary syndrome an overview sciencedirect topics. Prior to joining together at the midline to form the basilar artery, both the left and right. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Wallenberg syndrome pica syndrome lateral medullary. 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, 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. Now, let us move onto the discussion of medial medullary syndrome djerines syndrome. Medial medullary infarction clinical, imaging, and outcome study in 86 consecutive patients jong s. Begin 27 06 the lateral medullary syndrome transcription.
Thrombosis of the medullary branch produces the following signs and symptoms. Spectrum of lateral medullary syndrome ahaasa journals. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. 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. Some people have uncontrollable hiccups, loss of pain and temperature sensation on one side of the face, andor weakness or numbness on one. With early identification and treatment, including early swallowing evaluations, the. 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. Inferior medial pontine syndrome foville ventral pontine syndrome. The most common cause is a lateral medullary infarction, which produces a horner syndrome as part of the wallenberg syndrome. This situation causes lateral medullary infarct and medial medullary infarct simultaneously terminology. Medial medullary syndrome radiology reference article. 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. Wallenberg syndrome is a rare condition in which an infarction, or stroke, occurs in the lateral medulla. Typically, the patient presents with vertigo and ataxia. 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. There are two major vascular syndromes of the medulla oblongata. Hemimedullary syndrome is a rare syndrome in which both medial and lateral medullary lesions occur together with few reported cases. Pdf there are two major vascular syndromes of the medulla oblongata. Medial midpontine syndrome paramedian branch of midbasilar artery on side of lesion ataxia of limbs and gait more prominent in bilateral involvement. Multiple cranial nerve lesions neurosurgery resident. Pdf a case of lateral medullary infarction with cardiovascular autonomic dysfunction presenting as orthostatic hypotension with presyncope. May 22, 2017 wallenberg syndrome is a condition that affects the nervous system. Medial medullary syndrome results from an occlusion of a vertebral artery or the anterior spinal artery. Click on the link to view a sample search on this topic.
Wallenberg syndrome is also known as lateral medullary syndrome or the posterior. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. In many texts hemimedullary syndrome is incorrectly used as. Jun 19, 2017 cerebellar medullary compression syndrome. 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. On examination, he was conscious and had dysarthria. Paramedian base contains descending motor tracts and crossing cerebellar tracts paramedian tegmentum contains oculomotor pathways. Medial medullary syndrome genetic and rare diseases. Moderate irregular narrowing of bilateral intracranial icas, left va and ba. 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. Wallenberg syndrome is a condition that affects the nervous system. Right lingual paresis was observed on tongue protrusion fig 1a. 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.
The previously reported 14 cases of the medial medullary syndrome. This occurs within the medulla at the level of the olive and above the pyramidal decussation. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. Medial medullary syndrome online neuroanatomy lecture. 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. Signs and symptoms may include swallowing difficulties, dizziness, hoarseness, nausea and vomiting, nystagmus, and problems with balance. Thalamic pain syndrome dejerineroussy syndrome weber syndrome weber syndrome anterior inferior cerebellar artery. Here, i present a young patient with acute vertigo, progressive. Posterior to the pyramids in the midline is the medial. 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. Magnetic resonance imaging of medial medullary infarction. Weakness, sensory loss in arm and leg nausea, nystagmus, dysphagia, dysarthria medullary infarct on diffusionweighted imaging. Jun 12, 2017 medial medullary syndrome the medial part of the medulla oblongata is supplied by the vertebral artery. In addition, slight motor weakness, decreased joint position, and vibration.
Manual muscle testing showed that the strength in her left limbs. 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. Lateral medullary syndrome, also known as wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata. Treatment aims at reducing the size of infarction and preventing any. Medial medullary infarction is characterized by ipsilateral hypoglossal nerve palsy, contralat eral hemiparesis. Vascular lesions of the brainstem illustrate the location of nuclei and tracts. Medial medullary syndrome dejerine syndrome internet. Lateral pontine syndrome mariefoix syndrome posterior inferior cerebellar artery. Lateral medullary syndrome radiology reference article. Medial medullary infarctions mmi were reported in less than 40 patients with satisfactory clinicotopographic documentation. This lesion could also be due to an issue with blood delivery through the vertebral artery. Tongue weakness sensory loss in face horners syndrome ataxia palate weakness dysphagia contralateral signs. The internet stroke centre has an excellent summary of stroke syndromes. Wallenbergs syndrome information page national institute.
The main blood supply is from the two vertebral arteries, joining at the pontomedullary. They enter the skull through the foremen magnum and merge to form the. The previously reported 14 cases of the medial medullary. Wallenberg syndrome genetic and rare diseases information. Dejerine syndrome definition of dejerine syndrome by. Mmi represented less than 1% of ischemic strokes in the posterior circulation. This is most commonly due to occlusion of the intracranial portion of the vertebral artery followed by pica and its branches. 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. Lateral medullary syndrome is also called wallenbergs syndrome, posterior inferior cerebellar artery pica. Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery. 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.
In this case report we present a patient who developed mms secondary to takayasu arteritis ta. There is a list of classical stroke syndromes arranged by arterial terriotry, which one needs to commit to memory. Ta is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of. Bilateral medial medullary syndrome secondary to takayasu.
This results in the infarction of medial part of the medulla oblongata. The medial medullary syndrome is a result of blockage of the anterior spinal artery or. Wallenberg syndrome is also known as lateral medullary syndrome or the. Clinical, imaging, and outcome study in 86 consecutive.
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. Mechanism of medullary infarction based on arterial. The medial medullary syndrome jama neurology jama network. Lateral medullary syndrome wallenberg syndrome ataxic hemiparesis. Medial pontine syndrome affects structures at the bottom of the diagram. Medullary pyramid an overview sciencedirect topics. 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. 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. Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal alternating hemiplegia, lower alternating hemiplegia, or dejerine. 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.
Less than 1% of all posterior circulation infarctions present as medial medullary syndrome, bilateral being even rarer 1, 2. Medial medullary syndrome due to vertebral artery dissection. History a 54yearold black male presented emergently to the office with an acute headache and diplopia that had persisted for two days. Bilateral medial medullary syndrome presenting with heart appearance sign suryanarayana sharma p. The anterior spinal artery syndrome was first described by spiller 1 in a case of thrombosis of this artery. Rare stroke syndrome medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss.
Hemimedullary syndrome radiology reference article. Lateral medullary infarction commonly presents with homers syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. Lateral medullary syndrome may be complete or partial depending on the vessel and the subsequent vascular territory involved. 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 most common mechanism of medial medullary infarction in a recent study was smallvessel occlusion, 20 which is consistent with our findings. Corticobulbar and corticospinal tract variable impaired touch and proprioception when lesion extends. Lacune typically account for 2025% of stroke patients. Short segment of signal loss at origin of right va, propably focal stenosis medial medullar syndrome of. Han, md background and purposeclinicalimaging correlation and longterm clinical outcomes remain to be investigated in medial medullary infarction mmi. A 60 year old man with hypertension and diabetes mellitus sought neurological consultation for sudden onset of numbness over the left side of body. Furthermore, signs and symptoms of medial medullary syndrome may vary on an individual basis for each patient. The main blood supply is from the two vertebral arteries, joining at the. As a result, treatment of wallenberg syndrome varies depending on the. The medial medullary syndrome is characterized by the.
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. 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. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. The other neurological findings included left lemniscal sensory impairment and mild left haemiparesis without. Key words cerebra l latera infarctionl medullary syndrome magnetic resonanc stroke imagine g assessment yond the dorsolateral portion were included the 33. 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. 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.
Inferior medial pontine syndrome foville ventral pontine syndrome millard. Active exercises to strengthen swallowing musculature. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c. The medial medullary syndrome khangloon ho, md, kenneth r. What are the symptoms of the lateral medullary syndrome.
Pontine nuclei on side opposite lesion paralysis of face, arm, and leg. Brainstem stroke syndromes ppt linkedin slideshare. The diagnosis usually is made on the basis of clinical findings because the cause of the. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. It is located in between median fissure and ventrolateral sulcus. 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. 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. 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.