Bilateral medial medullary infarction with oculomotor disorders.

Abstract

Background and Purpose:We describe the first case of bilateral medial medullary infarction demonstrated by magnetic resonance imaging. We discuss the relation between this lesion and the oculomotor signs that were observed clinically.Case Description: A 71-year-old man initially presented with pure motor hemiparesis, which progressed to complete quadriplegia. He also developed nearly complete vertical and horizontal ophthalmoplegia. Magnetic resonance imaging revealed upper medial medullary infarctions bilaterally that extended to the pontomedullary junction.Conclusions: We propose that the vertical oculomotor disorders resulted from involvement of the oculomotor system in the caudal brain stem, especially the caudal paramedian pontine reticular formations on both sides. (Stroke 1992;23:1657-1659 KEY WORDS • cerebral infarction • cerebrovascular disorders • magnetic resonance imaging • medulla oblongata • ocular disease I nfarction of the medial medulla oblongata has been rarely reported, even during the era of magnetic resonance imaging (MRI), a technology that can detect small lesions in the posterior fossa.1 Because of the rarity of this syndrome, clinical features such as disturbance of oculomotor control are still controversial. We report the first case, to our knowledge, in which bilateral medial medullary infarction was clearly demonstrated by MRI and discuss the relation between this anatomic lesion and the oculomotor signs appearing in this patient.Case Report A 71-year-old man with a history of hypertension and smoking awoke with a right hemiparesis. He was admitted to our hospital the day after symptoms began. On admission, his pulse rate was 80 beats per minute, blood pressure was 202/110 mm Hg, and respirations were 18 per minute and regular. He was alert, with normal higher cortical function. His speech was dysarthric. The visual fields were intact; pupils were equal, with a normal light reflex; and ocular movements were full and smooth, without nystagmus. A mild right hemiparesis was present involving the face and tongue. The rightsided deep tendon reflexes were slightly increased. There were no sensory deficits to touch, pain, temper-

Lateral and Medial Medullary Infarction

“…For MMI in particular, most reports have dealt with 1 or a few cases of MMI. [1][2][3][11][12][13] Some larger studies included 18 and 14 cases of MMI (Kim et al 14,18 ) and 11 cases of MMI (Toyoda et al 15 and Kumral et Limitation of ocular movement 6 Taste disorder 3…”

Heart in Brain

“…Bilateral MMI should be suspected in patients presenting with acute onset quadriparesis, tongue weakness and facial sparing. Limb weakness, respiratory failure, aspiration pneumonia, uro-sepsis and pulmonary thromboembolism are important cause of mortality and seen in significant number of cases [2]. Computed tomography scan of brain is not a sensitive tool for posterior fossa, especially for medullary infarcts as in our case, CT scan of brain was normal even after three days of onset of symptoms.…”

“…Medial medullary infarction is a rare occurrence and represents <1% of posterior circulation strokes [1]. Bilateral MMI is even rarer stroke subtype and only 12 anatomically proven cases have been reported in English literature till date [2]. Subsequently, with advances in imaging technology with widespread use of MRI in diagnosis of acute ischemic strokes worldwide, additional 38 cases have been reported in the last 20 years.…”

Delayed Central Respiratory Dysfunction After Wallenberg's Syndrome. Case Report.

“…5) For instance, bilateral medial medullary infarction involving the nucleus parabrachialis medialis does not always cause respiratory failure. 2,8) Unilateral lateral medullary infarction is one of the smallest lesions known to cause central respiratory dysfunction, 1,7) and also causes Wallenberg's syndrome. However, previous cases of central respiratory dysfunction associated with Wallenberg's syndrome occurred in the acute stage.…”