Functioning adrenal lesions can also give clues to the histologic diagnosis and direct workup. Lateral medullary syndrome is a neurological disorder causing a range of symptoms due to. Medial pontine syndrome affects structures at the bottom of the diagram. Medial medullary infarction mmi was first described in the 19th century by spiller. View full size version of medial medullary syndrome. Medial and lateral medullary syndrome see online here brain stem syndromes are characterized by in. Medial medullary syndrome, also known as dejerine syndrome, is secondary to thrombotic or embolic occlusion of small perforating branches from vertebral or. Definition of medial medullary syndrome in the medical dictionary by the free dictionary. Medial medullary syndrome dejerine syndrome internet stroke. Mechanism of medullary infarction based on arterial. Lateral medullary syndrome, also known as wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata. Background and purpose with advanced imaging techniques, infarctions occurring in the medulla are now more easily identified.
The disorder is likely to be complicated by nephrocalcinosis, urolithiasis, tubular dysfunctions, and urinary tract infections. Four patients with a clinical diagnosis of wallenbergs lateral medullary syndrome were studied with both magnetic resonance imaging mri and cranial computed tomography ct. The infarcts documented by mri were unilateral in 10 patients and bilateral in. The medial medullary syndrome, also known as dejerine syndrome, is caused by infarction of this region. Typically, the sagittal plane is optimal for visualizing the proximal portion of the celiac axis, and in many cases, 3d imaging also allows identi. Medial medullary syndrome medial medullary syndrome, also known as dejerine syndrome, is secondary to thrombotic or embolic occlusion of small perforating branches from v. As lesions were often invisible or vague on initial ct or dwi in patients who underwent imaging. Thirteen patients with wallenberg s lateral medullary syndrome were examined with conventional and echoplanar diffusionweighted magnetic resonance mr imaging in a 1. Treatment for lateral medullary syndrome is dependent on how quickly it is identified. Medial medullary syndrome radiology reference article.
The aim of this retrospective observerblinded study was to determine the frequency and extent of horizontal conjugate eye deviation in the initial imaging in patients with acute unilateral lateral medullary infarction compared to patients with transient brainstem. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. Relevant appraisal of anatomy and blood supply of medulla is essential to understand the peculiar features of medullary syndromes. Serial magnetic resonance imaging shows separate medial. Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c facial palsy, ataxia, vertigo, nystagmus, dysphagia. The content on the uptodate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Neuroimaging strategies for three types of horner syndrome. Medial medullary syndrome inferior alternating dejerines syndrome corticospinal tract loss of voluntary motor function on the contralateral side medial lemniscus loss of touch, pressure, vibratory sense on the contralateral side hypoglossal nucleus loss of voluntary motor function to the tongue on the ipsilateral side. Conclusionmmi usually presents with a rostral medullary lesion, with a good clinical ventrodorsal imaging correlation, caused most frequently by abo followed by svd. Transcranial magnetic stimulation was used to investigate the corticofacial projections in 53 patients with n 28 and without n 25 central facial paresis due to unifocal ischaemic lesions at different brainstem levels.
Lateral medullary syndrome is a descriptor in the national library of medicines controlled vocabulary thesaurus, mesh medical subject headings. Previous studies have revealed characteristic clinicolesion correlations in patients with medullary infarctions, and particularly those between the medial and the lateral medulla. Bilateral medial medullary infarction, diffusionweighted magnetic resonance imaging. No correlation was noted between facial weakness or ocular symptoms and infarction extending beyond the lateral medullary region. The project we created to study lateral medullary syndrome includes 3d models of a randomized ct scan to demonstrate the brainstem with major tracts, cranial nerves and nuclei, and additional structures. The diagnostic value of the blink reflex is well established in patients with peripheral and brainstem lesions. Medial inferior pontine syndrome is a condition associated with a contralateral hemiplegia medial pontine syndrome. Magnetic resonance imaging, obtained in 22 cases, was normal in two. The topography of the lesion and the absence of flow in the right vertebral artery favoured infarction over demyelination as the likely aetiology. Medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal. Lateral medullary syndrome radiology reference article. Medial medullary syndrome definition of medial medullary. The ischemia is a result of a blockage most commonly in the vertebral artery or the posterior inferior cerebellar artery. Yutaka kametsu 1, shigeharu takagi 1, munetaka haida 1, tsuneyuki takeoka 1, yukito shinohara 1 1 department of neurology, tokai university school of medicine released 20090903.
Medial midbrain syndrome upper basilar and proximal pca ipsilateral cn iii eye. Click on the link to view a sample search on this topic. Lesion topography documented by mri studies was correlated with the electrophysiological findings. The r1 loop probably runs from the trigeminal entrance zone at the lateral midpons to the ipsilateral facial nucleus, passing through or. Primary adrenal lesions can further be either of cortical or medullary origin.
A significant proportion of patients remain dependent. Also called cats cry or 5p 5p minus syndrome, its a deletion on the short arm of chromosome 5. Wallenberg syndrome is a neurological condition caused by a lateral medullary infarction, which results from occlusion of either the posterior inferior cerebellar artery pica or the vertebral artery. First described in 1908 by spiller, medial medullary syndrome is characterized by damage and dysfunction of the medial medullary structures. Lateral medullary syndrome is also called wallenbergs syndrome, posterior inferior cerebellar artery syndrome and vertebral artery syndrome.
Anterior spinal artery syndrome results in the occlusion of the artery at the level of the spine. Subjective visual vertical and horizontal abnormalities in a patient with lateral medullary syndrome a case report amit kumar tyagi1,gaurav ashish1, anjali lepcha1, achamma balraj1 abstract introduction. Mri correlation in patients with lateral medullary infarction lmi. Dejerine introduced the triad of contralateral hemiplegia sparing the face, contralateral loss of deep sensation and ipsilateral hypoglossal paralysis to this disease, now also known as dejerine syndrome. It results in neurologic deficits involving the respiratory, cardiovascular, speech, swallowing, hearing and ocular movement centers located within the brain stem. Introduction bilateral medial medullary infarction mmi is a rare stroke syndrome and only a handful of cases. It affects the pyramid, medial lemniscus and hypoglossal nerve fig. Sorensen ag, halpern ef, ay h, he j, koroshetz wj, gonzalez rg. Acute diffusion defect of anterior part of medulla oblongata was observed on diffusion weighted imaging dwi and the patient was diagnosed with medial medullary syndrome. Brain stem infarction is a potentially lifethreatening condition which develops due to focal ischemia of the midbrain, pons, and medulla oblongata. For this reason, it is also referred to as lateral medulla syndrome or pica syndrome. Clinical, imaging, and outcome study in 86 consecutive. A, sagittal t2weighted mr image of brachial plexus shows hypointense. 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.
In addition, it may be rarely associated with extrarenal anomalies. 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 deep sensation. Subjective visual vertical and horizontal abnormalities in. There have been several reports on mri of the classic medullary vascular syndromes such as dorsolateral infarction and medial infarction. This results in the infarction of medial part of the medulla oblongata. Ct and conventional and diffusionweighted mr imaging in acute stroke. Medial medullary infarct is associated with clinical triad of ipsilateral hypoglossal palsy, contralateral hemiparesis, and contralateral lemniscal sensory loss. This syndrome is an uncommon lesion resulting from occlusion of a vertebral artery or its branch to the anterior spinal artery. Descriptors are arranged in a hierarchical structure, which enables searching at various levels of specificity. Neuroimaging strategies for three types of horner syndrome with emphasis on anatomic location jeong hyun lee1.
The medial medullary syndrome is a result of blockage of the anterior spinal artery or medial medullary branches of the vertebral artery. Nephrocalcinosis in adolescent girl with medullary sponge. Lateral medullary syndrome harvard catalyst profiles. The figures in this poster are screenshots from the final video presentation created using the amira analytical software package. Imaging tests we comply with the health on the net hon code of standards for trustworthy health information. Clinicotopographic correlation of small vertebrobasilar infarct using magnetic resonance imaging. The neurological problem was ascribed to right medial medullary infarction due to occlusion of antero. Medial medullary syndrome genetic and rare diseases. Medial medullary syndrome dejerine syndrome internet. Magnetic resonance imaging in wallenberg s lateral medullary syndrome.
Variable manifestations may include isolated hemiparesis, tetraparesis, ipsilateral hemiparesis, i or c facial. On follow up 9 months after the diagnosis and subsequent treatment, the patient showed significant improvement on all fronts. 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. This project is supported in part by the nih specialized programs of translational research in acute stroke spotrias network, and ninds grant 3p50ns055977 to washington university in st. A case of medial medullary syndrome, and its magnetic resonance imaging.
Medullary sponge kidney msk is a rare congenital abnormality characterized by cystic dilatation of the medullary collecting tubules. 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. What are the signs and symptoms of medial medullary syndrome in. It consists ipsilateral tongue weakness, contralateral limb weakness, and contralateral loss of touch, proprioception, and vibration sense due to involvement of the hypoglossal nerve, corticospinal tract, and medial leminiscus.
Among 4200 consecutive patients admitted to three hospitals with acute ischemic stroke, we found only 11 patients in whom magnetic resonance imaging mri had proved that they had medial medullary infarction mmi. A case of medial medullary syndrome, and its magnetic. Diagnosis is based on clinical presentation with computed tomography and magnetic. Wallenberg syndrome results from involvement of the lateral medulla, usually by ischemic stroke, and presents with a characteristic clinical signature. Medial medullary syndrome an overview sciencedirect topics. Conjugate eye deviation in unilateral lateral medullary. Wallenberg syndrome genetic and rare diseases information center gard an ncats program. Medial medullary syndrome mms student doctor network. Among 4200 consecutive patients admitted to three hospitals with acute ischemic stroke, we found only 11 patients in whom magnetic resonance imaging mri.
Over the years, various imaging techniques have been developed that have increased diagnostic accuracy and helped in better characterization of adrenal lesions noninvasively. Medullary definition of medullary by medical dictionary. Evaluation of persistent vertigo in post infarct patients is very important as the management. 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. Blink reflex r2 changes and localisation of lesions in the. Pubmed is a searchable database of medical literature and lists journal articles that discuss medial medullary syndrome. Wallenberg syndrome knowledge for medical students and.
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