Risk Factors for Long-Term Death After Medullary Infarction: A Multicenter Follow-Up Study

Zhang, Dao Pei; Liu, Xiang Zhe; Yin, Suo; Qian, Kun; Yu, Meng; Zhang, Huai Liang; Wang, Xin Zhi; Zhang, Jie Wen

doi:10.3389/fneur.2021.615230

Cited by 3 publications

(3 citation statements)

References 28 publications

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“…This was investigated in a study performed in a stroke unit investigating the association. This reported case had good prognostic signs including age and absence of dysphagia as proved in a multi-center study [20]. Hence, it was important after the development of swallowing symptoms to perform radiological re-evaluation in this case which was consistent with the new symptomatology.…”

Section: Discussionsupporting

confidence: 59%

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Florid Autonomic Features Associated with Medullary Lacunar Stroke

Elsayed¹,

Harazeen²,

Shams³

et al. 2022

IJCM

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Introduction: Autonomic nuclei affection results in variations in hemodynamics, temperature, sweating and ECG. Medullary strokes are challenging in their presentation, bizarre clinical signs, work and neurological outcome. The commonest cause is infarction of the posterior inferior cerebellar artery (PICA). Anatomical areas affected include the inferior cerebellar peduncle, dorsolateral medulla, nuclei of the Trigeminal, vestibular nuclei, Ninth and Vagus nerves. The descending sympathetic tracts and spin thalamic tracts. Serious cardiopulmonary events can complicate 11% of cases. Case Presentation: A middle-aged female developed sub-acute dizziness associated with vomiting and right head pains. She was unable to walk but remained cognitively clear. Her gastrointestinal symptoms were disabling and this was the main factor for presenting to the emergency room. The risk factors included hypertension and diabetes mellitus. Imaging studies were essential for posterior circulation stroke diagnosis and follow-up. She manifested remarkable autonomic features regarding the skin and hemodynamics. Nevertheless, the hospital course was controllable. Discussion: This case report was consistent with relevant literature in the contra lateral vaso motor changes and drop in body temperature during the acute phase. Moreover, our patient developed clinical and radiological extension through double antiplatelets. Superiority of the magnetic resonance imaging (MRI) scans in this patient enabled better diagnostic accuracy in a brainstem stroke. Conclusion: The autonomic features, in this case, represent major symptomatology and clinical signs. The variation in the hemodynamics and persistence of symptoms is thought provoking. This increases the awareness of emergency doctors for acute stroke presenting with autonomic features will enable early detection and helps outcome.

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Section: Discussionsupporting

confidence: 59%

“…They found that poor long-term results and all cause mortality were not uncommon in medullary infarction. Age, dysphagia and recurrent strokes were the main predictors for that [20].…”

Section: Introductionmentioning

confidence: 94%

Florid Autonomic Features Associated with Medullary Lacunar Stroke

Elsayed¹,

Harazeen²,

Shams³

et al. 2022

IJCM

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“…In the study mentioned above by Kim K et al, the most common etiologies were LVD (34.5%), vertebral artery dissection (9.2%), and cardioembolic (4.2%) [ 11 ]. A study by Zhang DP et al in 2021 found LVD in 59%, SVD in 10.1%, CE in 4.5%, vertebral artery dissection in 11.2%, and unknown in 12.8% of patients [ 12 ]. A study of 130 patients with lateral medullary infarcts by Kim JS et al in 2003 showed large vessel infarction in 50%, arterial dissection in 15%, small vessel infarction in 13%, and cardiac embolism in 5% [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

An In-Depth Analysis of Medullary Strokes at a Tertiary Care Stroke Center: Incidence, Clinical and Radiological Characteristics, Etiology, Treatment, and Prognosis

Muhammad,

Ali,

Hussain

et al. 2023

Cureus

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Introduction Medullary infarctions (MI) are a rare medical entity that is classified mainly as the more commonly lateral medullary infarcts (LMI) and the less common medial medullary infarcts (MMI). Lateral medullary syndrome, also known as Wallenberg syndrome, results when the medulla oblongata is affected and predominantly occurs secondary to atherosclerotic occlusion of the vertebrobasilar arteries. Previous studies have focused more on the anatomical, clinical, and topographical aspects of medullary infarcts. We describe the incidence of their presentation, radiological findings, etiology, treatment, and outcome at our comprehensive stroke center. Material and method This is a retrospective cohort study of 108 medullary stroke patients with confirmed clinical and radiological diagnoses of MI at Hamad General Hospital, Doha, between January 1, 2018 and December 31, 2020. We evaluated the electronic medical records of all stroke patients. Result During the selected period, a total of 2,912 ischemic strokes were reported. Of these, 843 (28.8%) were posterior circulation strokes. Only 108 (3.7%) patients had medullary strokes. Commonly encountered neurological features were dizziness (94.4%), limb ataxia (84.3%), dysarthria (44.4%), ipsilateral facial sensory loss (32.4%), headache (32.4%), contralateral limb sensory loss (25%), ipsilateral hemiparesis (24%), dysphagia (19.4%), and hiccups (13%). Most strokes reported were either minor (73% with National Institutes of Health Stroke Scale [NIHSS] 1-4) or moderate (26% with NIHSS 5-15). LMIs (87.9%) were the most common, followed by medial paramedian MI (10%). Twenty-five percent had extramedullary involvement, predominantly of the cerebellum (17.6%). Out of the total number of patients, 44 (40.7%) had large vessel atherosclerotic disease, followed by 41 (37.6%) whose stroke was due to small vessel disease, 15 (13.8 %) due to undetermined etiology, and 6 (5.5%) due to arterial dissection. Twenty-eight patients (25.4%) underwent 48-hour Holter monitoring, which detected atrial fibrillation in two patients (1.85%). The majority of patients (98.2%, or 106 patients) received antiplatelet therapy, while 68.5% (74 patients) received single antiplatelet therapy (SAPT), and 29.6% (32 patients) received dual antiplatelet therapy (DAPT). Noteworthy is that only 2.7% (three patients) received thrombolysis as an acute reperfusion therapy. Forty-seven percent (51 patients) were discharged home (mRS 0-2), and 51.9% (56 patients) were transferred to rehabilitation facilities. Follow-up assessments were performed at the stroke clinic for 57.4% (62) of the patients. The assessments found that 46 of the follow-up patients were functionally independent at that time (mRS 0-2). Conclusion This is the first large local study of medullary strokes to determine their frequency, presentation, etiology, treatment, and clinical outcome. Medullary strokes represent 3.7% of total ischemic strokes at ou...

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Bilateral Medial Medullary Infarct with Unique Radiological Presentation

Çakmakci,

Çetiner,

Uysal

et al. 2024

Acta Neurologica Taiwanica

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Bilateral medial medullary infarction (MMI) is a rare subtype of stroke. The typical heart-shaped appearance on magnetic resonance imaging is pathognomonic for the bilateral medial medullary syndrome. Vertebrobasilar dolichoectasia (VBD) is a condition characterized by tortuous dilatation and marked enlargement of the basilar and vertebral arteries, and it may cause posterior circulation infarction. We present a case of a 55-year-old female patient with complaints of speech disorder, regression in consciousness, and difficulty breathing. Diffusion-weighted imaging examination was normal on arrival. In the cranial imaging after 24 h, acute infarction was observed in the bilateral medial medullary area. Time-of-flight magnetic resonance angiography revealed VBD. In this report, a case of bilateral MMI with a unique radiological appearance accompanied by VBD, which is rarely reported in the literature, is presented.

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Risk Factors for Long-Term Death After Medullary Infarction: A Multicenter Follow-Up Study

Cited by 3 publications

References 28 publications

Florid Autonomic Features Associated with Medullary Lacunar Stroke

Florid Autonomic Features Associated with Medullary Lacunar Stroke

An In-Depth Analysis of Medullary Strokes at a Tertiary Care Stroke Center: Incidence, Clinical and Radiological Characteristics, Etiology, Treatment, and Prognosis

Bilateral Medial Medullary Infarct with Unique Radiological Presentation

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