There have been some reports of facial weakness resulting from a similar mechanism by medial medullary infarction,7 8 12 although it has been established pathologically that the facial nucleus received such corticobulbar fibres. Furthermore, signs and symptoms of medial medullary syndrome may vary on an individual basis for each patient. Medial medullary infarction caused by antineutrophil cytopla. Here, i present a young patient with acute vertigo, progressive generalized weakness, dysarthria, and respiratory failure, who initially was misdiagnosed with acute vestibular syndrome.
Show full abstract hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy, which had been regarded as a variant of medial medullary syndrome, turned out to be caused by lateral lower. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c. Wallenberg syndrome is also known as lateral medullary syndrome or the. Jun 19, 2017 if this video helped you, please subscribe to my channel, its always free. Medial medullary syndrome genetic and rare diseases. Progression of opalski syndrome to the hemimedullary and. Occlusion of the posterior inferior cerebellar artery pica causes the lateral medullary syndrome and infarction of lateral medulla. These videos are designed for medical students studying for the usmle step 1. 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 radiology reference article. Looking for online definition of medial medullary syndrome in the medical dictionary. Medial medullary syndrome an overview sciencedirect topics.
The most common cause is a lateral medullary infarction, which produces a horner syndrome as part of the wallenberg syndrome. Dejerine syndrome definition of dejerine syndrome by. Medial medullary syndrome online neuroanatomy lecture. We studied seven patients with mriproven acute mmi seen in two neurologic departments over a 5year period 19901994. Lateral medullary syndrome, case report journal of universal dec 30, 2016. 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. Find, read and cite all the research you need on researchgate. Five patients had an infarction above the pyramidal decussation.
Treatment aims at reducing the size of infarction and preventing any medical. Medial medullary syndrome in a drug abuser jama neurology. The topography of the lesion and the absence of flow in the right vertebral artery favoured infarction over demyelination as the likely aetiology. Mar 16, 20 medial superior pontine syndrome paramedian branches of upper basilar artery on side of lesion cerebellar ataxia probably. In a 55yearold woman, the medial medullary syndrome developed owing to infarction of the left medullary pyramid, ventromedial portion of the inferior olivar. 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. Cause of medial medullary djerine s 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. Dec 10, 2014 in addition, hemimedullary infarct or bilateral medial medullary infarct is a rare disease and a combination of both is even rarer 2.
Mar 19, 2012 these videos are designed for medical students studying for the usmle step 1. Central facial weakness due to medial medullary infarction. According to the national institute of neurological disorders and stroke, wallenberg syndrome aka lateral medullary syndrome or posterior inferior cerebellar artery syndrome is a neurological condition caused by a blockage of the vertebral artery va or posterior inferior cerebellar artery pica, ultimately leading to infarction of the. In the case of our patient, the infarction was difficult to diagnose because the patient had atypical features and a past history of head injury. This article cites 39 articles, 4 of which you can access for free at. We report a case of opalski syndrome that progressed to hemimedullary infarct and contralateral medial medullary infarct and suggest a possible pathologic mechanism for opalski syndrome. The first page of the pdf of this article appears above. Mar 23, 2017 lateral medullary syndrome wallenberg syndrome 1.
Medial inferior pontine syndrome is a condition associated with a contralateral hemiplegia medial pontine syndrome. Rare stroke syndrome medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. Mmi represented less than 1% of ischemic strokes in the posterior circulation. Medial medullary syndrome definition of medial medullary.
This syndrome is due to malperfusion in the territory of the anteromedial group of medullary arteries arising from the vertebral. Lateral medullary syndrome wallenberg syndrome prof. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. 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. If you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 toll free.
Medial medullary syndrome dejerine syndrome internet stroke. Click on the link to view a sample search on this topic. Bilateral medial medullary stroke is a very rare type of stroke, with catastrophic consequences. The branches of the anterior spinal artery that penetrate into medial portions of the medulla tend to alternate to the right and left. Pdf there are two major vascular syndromes of the medulla. Medial pontine syndrome affects structures at the bottom of the diagram. Medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal. Medial medullary syndrome results from an occlusion of a vertebral artery or the anterior spinal artery. Lateral medullary infarction commonly presents with horners syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. Typically, the patient presents with vertigo and ataxia. The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. This case is unique in that the medial medullary syndrome was apparently caused by an embolus of talc following its iv administration. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Deposits of talc, presumably from a medication prepared for oral use, were demonstrated in the small vessels in the area of the medullary infarction.
If this video helped you, please subscribe to my channel, its always free. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. The medial medullary syndrome jama neurology jama network. What are the signs and symptoms of medial medullary syndrome in. Medial medullary infarction caused by ancarelated vasculitis was diagnosed based on mild renal. The diagnosis of medial medullary syndrome dejerinesyndrome was made. 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. Medial longitudinal fasciculus myoclonic syndrome, of palate, pharynx, vocal cords, respiratory apparatus, face, oculomotor apparatus. This syndrome is an uncommon lesion resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery. Mar 18, 2020 in this article, we emphasize on clinical characteristics of medial medullary syndrome and lateral medullary syndrome in perspective of the topographical organization of medulla.
The medial medullary syndrome is characterized by the. Vertebral artery medial medullary syndrome dejerine syndrome. Medial medullary infarctions mmi were reported in less than 40 patients with satisfactory clinicotopographic documentation. Evaluation, and treatment of high blood pressure v. 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. Brain magnetic resonance imaging also showed right medial medullary infarction. Intracranial vertebral artery occlusion more often manifests with lateral. Nonetheless, we could diagnose the medial medullary infarction easily using diffusion mri within several hours of onset. Medial medullary syndrome and meningovascular syphilis. Pdf the medullary vascular syndromes revisited researchgate. Occlusion of these penetrating branches to one side of the medial medulla may result in a pattern of deficits characteristic of the medial medullary syndrome dejerine syndrome.
Wallenberg syndrome or lateral medullary infarction, is associated with the acute onset of vertigo and disequilibrium. To access free multiple choice questions on this topic, click here. She was treated with tablet aspirin 150 mg daily, tablet prednisolone 60 mg daily, tablet metformin ipr 1700 mgday, tablet glimepride. In this article, we emphasize on clinical characteristics of medial medullary syndrome and lateral medullary syndrome in perspective of the topographical organization of medulla. This results in the infarction of medial part of the medulla oblongata. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. Initial brain magnetic resonance imaging mri that was done in the acute phase was. Our patient presented with the classical clinical triad of dejerines syndrome, that includes ipsilateral hypoglossal palsy, contralateral haemiparesis, and lemniscal sensory loss. The neurological problem was ascribed to right medial medullary infarction due to occlusion of antero. 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, 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. This case illustrates features of the spectrum of medial medullary syndrome characterized by infarct involving the medial aspect of the medulla oblongata in the brain stem causing contralateral hemiplegiahemiparesis as well as a hemisensory loss with ipsilateral hypoglossal palsy ipsilateral tongue weakness and atrophy from the involvement of cn xii nucleus. Medial medullary infarction mmi syndrome was initially described by spiller more than 100 years ago, and dejerine. Medial medullary syndrome dejerine syndrome internet. 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. Superior andor middle cerebellar peduncle internuclear ophthalmoplegia. Medial medullary syndrome due to vertebral artery dissection. 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.
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