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. There is a list of classical stroke syndromes arranged by arterial terriotry, which one needs to commit to memory. Typically, the patient presents with vertigo and ataxia. According to a study, it is highest incidence is seen in middle aged males at 5060 years. Treatment aims at reducing the size of infarction and preventing any. The aim of the present study was to correlate the diverse mri lesions with the vascular lesions seen on conventional cerebral angiography in lmi. Asked in mechanical engineering what is the difference between transverse. The blood supply to the lateral medulla is the posterior inferior cerebellar artery. Lateral medullary syndrome, also known as wallenberg syndrome, is a clinical syndrome caused by an acute ischaemic infarct of the lateral medulla oblongata this is most commonly due to occlusion of the intracranial portion of the vertebral artery followed by pica and its branches.
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. Apr 20, 2020 lateral medullary syndrome is a neurological disease named for the area of injury from which it originates. The information contained in this web site is not a substitute for medical advice or treatment. There is loss of pain sensation on the rightsided face and leftsided trunk and limbs. Progression of opalski syndrome to the hemimedullary and. It affects the pyramid, medial lemniscus and hypoglossal nerve fig.
Pdf there are two major vascular syndromes of the medulla oblongata. The neurological problem was ascribed to right medial medullary infarction due to occlusion of antero. What are the signs and symptoms of medial medullary. Medial medullary syndrome dejerine syndrome internet stroke. Now, let us move onto the discussion of medial medullary syndrome djerines syndrome. Between wallenberg syndrome and hemimedullary lesion. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. Lateral medullary syndrome radiology reference article. Lateral medullary syndrome wallenberg syndrome internet. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences.
Medial medullary syndrome genetic and rare diseases. Ill let you mull over these rules until the next brainstem post, where youll be able to test drive gates brainstem rules of 4. Lateral medullary syndrome an overview sciencedirect topics. 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. Infarction, pica, lateral medullary syndrome, brain stem stroke,vertebral artery, innominate artery,posterior inferior cerebellar artery,wallenberg syndrome,a. Results for lateral medullary syndrome 1 10 of 50 sorted by relevance date. Medial medullary syndrome dejerine syndrome internet. 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. Patterns of sensory dysfunction in lateral medullary infarction. Inability to move the eyes conjugately to the ipsilateral side due to paramedian pontine reticular formation andor abducens nerve nucleus involvement. Lateral medullary syndrome may be complete or partial depending on the vessel and the subsequent vascular territory involved. Lesional location of lateral medullary infarction presenting. If this video helped you, please subscribe to my channel, its always free.
Lateral medullary syndrome occurs as a result of either vertebral or cerebellar artery occlusion. Unilateral lesion in the dorsal pontine tegmentum in the caudal third of the pons. Kwon m, lae jh, kim js 2005 dysphagia in unilateral medullary infarction. 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. There is rightsided vocal cord paralysis and absence of elevation of the right palate during phonation. 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. Like the lateral medullary syndrome, the medial medullary syndrome is closely associated with hypertension and atherosclerosis but. Wallenberg syndrome pica syndrome lateral medullary infarction. Jun 19, 2017 if this video helped you, please subscribe to my channel, its always free. The lateral medullary syndrome wallenbergs syndrome is most often caused by occlusion of the intracranial segment of the vertebral artery va, less commonly. Mechanism of medullary infarction based on arterial territory. Sensory deficits affecting the trunk torso and extremities on the opposite side of the infarction.
The topography of the lesion and the absence of flow in the right vertebral artery favoured infarction over demyelination as the likely aetiology. Unilateral laryngeal paralysis or vocal cord paralysis. Jun 14, 2006 in comparison with the lateral wallenberg, medial dejerine and hemimedullary reinhold medulla oblongata syndromes, the babinskinageotte and cestanchenais syndromes are much less familiar cerebrovascular disorders. Rare stroke syndrome medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. The aim of this study was to investigate them through the use of cooperatively collected cases. Hemimedullary syndrome is a rare syndrome in which both medial and lateral medullary lesions occur together with few reported cases. Recovery pattern of dysphagia in lateral medullary. Of 2, consecutive patients admitted to two hospitals with acute brain infarction, we examined 11 patients 0. To evaluate the relation between the lesional loci of lateral medullary infarction and hiccups. Background and purposecorrelation of mri findings with various vascular pathologies has rarely been attempted in patients with lateral medullary infarction lmi. Ipsilateral, ataxia arm and leg, restiform body, cerebellum.
The syndrome is also known as lateral medullary infarct lmi or posterior inferior cerebellar artery syndrome pica. The most common mechanism of medial medullary infarction in a recent study was smallvessel occlusion, 20 which is consistent with our findings. To study dysphagia in pure, unilateral medullary infarction using video fluoroscopic swallowing vfs tests and to compare the results between lateral medullary infarction lmi and medial. Jan 22, 2016 now, let us move onto the discussion of medial medullary syndrome djerines syndrome. The most common mechanism of medial medullary infarction in a recent study was smallvessel occlusion, 20 which is. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Medullary infarcts and hemorrhages chapter 40 stroke. Lateral medullary syndrome and lateral pontine syndrome mnemonic cool fact. What is the difference between medial lemniscus and. Discussion will contain basic neuroanatomy of the brainstem from a clinicians perspectiv. The neurological problem was ascribed to right medial medullary infarction due to occlusion of antero medial medullary artery, originating from right vertebral artery.
Mechanism of medullary infarction based on arterial. Jun 29, 2012 lacunar infarction was an infrequent mechanism in patients with medullary infarctions, and all patients with lacunar infarctions involved the anteromedial and anterolateral territories in our study. The diagnosis is made clinically and with the help of magnetic resonance imaging. Lateral medullary syndrome is relatively more common. Click on the link to view a sample search on this topic.
Medial medullary syndrome, also known as inferior alternating syndrome, hypoglossal. Palatal and pharyngeal weakness rare in pure mmi, common in lateral medullary infarct. 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. Aydogdu i, ertekin c, tarleci s, turman b, kiylioglu n, et al. Lateral medullary syndrome definition of lateral medullary. Lateral medullary syndrome wallenberg syndrome prof. She was shaky and sweaty, raising the possibility of pheochromocytoma. Lateral medullary syndrome an overview sciencedirect. Central poststroke pain and wallenbergs lateral medullary infarction. Brainstem rules of 4 litfl neurology clinical exmaination.
Recovery pattern of dysphagia in lateral medullary infarction. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. Medial medullary syndrome an overview sciencedirect topics. 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. The internet stroke centre has an excellent summary of stroke syndromes. 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.
On physical examination, there is a rightsided horners syndrome. 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 2a,b with the middle medulla most frequently affected. 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. That is, patient is unable to look toward the lesion. Sujatha parthasarathy md 1, jitphapa pongmoragot md 1, daniel selchen md frcpc 1, gustavo saposnik md msc faha 1 stroke research unit, division of neurology, department of medicine, st. 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. Medial medullary syndrome radiology reference article. What is the difference between medial medullary syndrome. Wallenberg syndrome is a rare condition in which an infarction, or stroke, occurs in the lateral medulla. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. Methods medical information on all patients from 1996.
Medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. The medial medullary syndrome jama neurology jama network. Start studying anatomy of medial and lateral medullary syndrome. There is a loss of pain and temperature sensation on the contralateral opposite side of the body and ipsilateral same side of the face. This list includes dominant and nondominant mca infarction, medial and lateral medullary syndromes, anterior and posterior cerebral artery syndromes and the basilar artery syndrome. Lateral medullary syndrome also known as wallenberg syndrome, after the physician who initially described the neurological features of the disease is a form of stroke that occurs due to inadequate oxygen and nutrient supply of various parts of the brain because of arterial occlusion. However, the anatomic basis for this syndrome is not clear. Lacune typically account for 2025% of stroke patients. 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. Lateral medullary or wallenbergs syndrome is characterized by vertigo, diplopia. The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. Lateral medullary syndrome aka wallenberg syndrome and posterior inferior cerebellar artery syndrome pica is a disease 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. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c. Wallenberg syndrome or lateral medullary infarction, is associated with the acute onset of vertigo and disequilibrium.
If there are signs of both a lateral and a medial paramedian brainstem syndrome, then one needs to consider a basilar artery problem, possibly an occlusion. 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. Hypertension, diabetes, smoking, and atherosclerosis are its major risk factors. Their importance may be underestimated and they can cause distress, exhaustion, and aspiration. Lateral and medial medullary infarction aha journals.
Wallenbergs syndrome is a lateral medullary infarction that causes vertigo, ipsilateral paralysis of the soft palate, larynx, and pharynx, dysphonia, dysphagia, ipsilateral facial numbness and loss of corneal, reflexes, ipsilateral, horners syndrome, ipsilateral cerebellar asynergy, and hypotonia. Most of her findings were consistent with lateral medullary syndrome, but she had some pontine involvement, and some features of medial medullary syndrome. Article abstractsensory dysfunction in lateral medullary infarction lmi has been insufficiently studied. Dysphagia in unilateral medullary infarction lateral vs. Background and purposeno largescale study has ever compared the clinical and radiological features of lateral medullary infarction lmi and medial. The infarcts documented by mri were unilateral in 9 patients and bilateral in 2 patients, and located in the anteromedial arterial territory of the upper or middle part of the medulla. There are very few clinically and pathologically proven patients of medial medullary syndrome. Sensation of pain and temperature is preserved, because the spinothalamic tract is located. Click export csv or ris to download the entire page or use the checkboxes to select a.
Wallenberg syndrome pica syndrome lateral medullary. Pdf the medullary vascular syndromes revisited researchgate. Medial and lateral medullary syndrome see online here brain stem syndromes are characterized by in. In addition, hemimedullary infarct or bilateral medial medullary infarct is a rare disease and a combination of both is even rarer 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. Here, i present a young patient with acute vertigo, progressive. The most common cause is a lateral medullary infarction, which produces a horner syndrome as part of the wallenberg syndrome. Her cerebral angiogram showed bilateral lesions at the c12 level typical of chiropractic injury, and upon questioning. Background and purpose no largescale study has ever compared the clinical and radiological features of lateral medullary infarction lmi and medial medullary infarction mmi. While the babinskinageotte syndrome is usually confused with the hemimedullary syndrome, reports of the extremely rare cestanchenais syndrome are missing from the modern. Wallenberg syndrome pica syndrome or lateral medullary infaction return to. Wallenberg syndrome is also known as lateral medullary syndrome or the. Lateral medullary syndrome video lecture made simple. Lateral medullary syndrome, also known as wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata this is most commonly due to occlusion of the intracranial portion of the vertebral artery followed by pica and its branches.
However in opalski syndrome1 and babinskinageotte syndrome,2 lateral medullary syndrome is associated with hemiplegia. Discussion will contain basic neuroanatomy of the brainstem from a clinicians perspective details of the blood supply of the brainstem various syndromes caused by stroke involving the brainstem vessels rule of four a very simple way to remember various brainst. Literature analysis and case studies karen sheffler, ms, cccslp. Hiccups in lateral medullary infarction remain poorly understood objective. Other terms in the literature wallenberg syndrome lateral medullary infarct lmi most common form of a brainstem stroke.
Hiccups are an infrequent result of lateral medullary infarction. Opalski syndrome is a rare variant of the lateral medullary syndrome of wallenberg accompanied by an ispilateral hemiparesis 1. It is sometimes called posterior inferior cerebellar artery syndrome because the condition involves a. This syndrome is an uncommon lesion resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery. Rare stroke syndrome 1% of vertebrobasilar strokes, bassetti et al. This results in the infarction of medial part of the medulla oblongata.