Babinski-Nageotte’s syndrome and Hemimedullary (Reinhold’s) syndrome are clinically and morphologically distinct conditions

Abstract

A hemimedullary infarction, in which medial and lateral medullary lesions occur simultaneously, is a rare cerebrovascular disease. It has been suggested that the Babinski-Nageotte's syndrome is the classical brainstem syndrome that corresponds to hemimedullary lesion. In this study we compare clinical symptoms and magnetic resonance imaging (MRI) data of two patients exhibiting classical Babinski-Nageotte's syndrome according to the original description with symptoms and MRI data of a patient with clinically complete hemimedullary lesion. Our study shows that Babinski-Nageotte's syndrome is neither clinically nor on MRI identical with hemimedullary lesion. Hypoglossal palsy, an invariable symptom of hemimedullary syndrome, is not part of the Babinski-Nageotte's syndrome according to the original description. Consistent with the original historical report, Babinski- Nageotte's syndrome is a lateral "Wallenbergian" medullary lesion with a spreading of the lesion to the more basal localised pyramidal tract. The clinical features of the hemimedullary syndrome, described in 1894 by Reinhold, and the MRI appearances in our patient with this syndrome are clearly different from other classical brainstem syndromes and should be called Reinhold's syndrome.

Between Wallenberg syndrome and hemimedullary lesion

“…Subsequently, hemimedullary infarctions were repeatedly published as the Babinski-Nageotte syndrome [4,5,8,14,17]. The real Babinski-Nageotte syndrome as a ''Wallenberg with hemiparesis'' is due to a spreading of the ''Wallenbergian'' lateral lesion to the pyramidal tract described by the French authors [1] has remained unfamiliar [10]. Even in the actual edition of ''DeJong's neurologic examination'' the hemimedullary syndrome was called Babinski-Nageotte syndrome [2], although the great Joseph Babinski and his assistant Jean Nageotte never had described the hemimedullary syndrome.…”

“…Hemimedullary syndrome is an uncommon disease. About 10 patients with this syndrome have been previously reported [9,10,13]. In comparison with these three syndromes of the medulla oblongata, the Babinski-Nageotte [1] and CestanChenais [3] syndromes are much less familiar cerebrovascular diseases.…”

Hemimedullary infarct with ipsilateral hemiplegia: A vertebral artery dissection syndrome?

“…Hemimedullary syndrome, which combines all the clinical features of lateral and medial medullary lesions, is very rare [4]. Although hemimedullary syndrome has been referred to as Babinski-Nageotte's syndrome in several reports, including our own [5], and in textbooks, some authors argue that the most suitable eponym is Reinhold's syndrome [2,3]. In patients with hemimedullary syndrome, the presence of ipsilateral, rather than contralateral, hemiplegia is rare [6,7].…”

“…Wallenberg's, Dejérine's, Babinski-Nageotte's, Reinhold's, and Cestan-Chenais' syndrome) have been described [1][2][3]. Wallenberg's syndrome, or lateral medullary infarction, is the most common, followed by the medial medullary syndrome of Dejérine.…”

Hemimedullary Syndrome with Ipsilateral Sensorimotor Deficits

“…Diffusionweighted imaging revealed a hyperintense lesion in the right dorsolateral medulla oblongata and FLAIR imaging showed a hyperintense lesion in the right medial and lateral medulla oblongata with extension of the lesion in the cervicomedullary junction Dear Sir, Hemimedullary syndrome has been introduced as Babinski-Nageotte syndrome or Reinhold syndrome with ischemic lesion in unilateral lateral and medial medulla oblongata [1][2][3] . The identity of hemimedullary stroke has remained controversial because both medial and lateral medullary infarctions rarely occur simultaneously and vascular supplies of the medial and lateral medulla usually differ [4,5] .…”