Spectrum of medial medullary infarction: clinical and magnetic resonance imaging findings

Kumral, Emre; Afşar, Nazire; Kırbaş, Dursun; Balkır, Kaan; Özdemirkıran, T.

doi:10.1007/pl00007852

Cited by 86 publications

(56 citation statements)

References 35 publications

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“…Although ipsilateral hypoglossal nerve palsy is one of the triads of MMI, 2 its prevalence has been variably reported as 11% to 18% 4,5 or 71% to 82%. 6,7 The discrepancies may be explained by different degrees of lesion extension; in the latter studies, combined lateral and medial medullary infarcts were included, and most patients had lesions extending to Ն2 retro-caudal levels whereas most of our patients and those from the former studies had lesions strictly limited to the paramedian rostral area that could have less severely damaged the hypoglossal fascicle/nuclei. Instead, we more often observed clumsy tongue movements, with occasional contralateral tongue deviation, suggesting that dysarthria/dysphagia are largely caused by involvement of the corticobulbar tract rather than hypoglossal nerve.…”

Section: Discussionmentioning

confidence: 85%

Medial Medullary Infarction

Kim

Han

2009

Stroke

105

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Background and Purpose-Clinical-imaging correlation and long-term clinical outcomes remain to be investigated in medial medullary infarction (MMI). Methods-We studied clinical, MRI, and angiographic data of 86 consecutive MMI patients. The lesions were correlated with clinical findings, and long-term outcomes, divided into mild and severe (modified Rankin scale Ͼ3), were assessed by telephone interview. Central poststroke pain (CPSP) was defined as persistent pain with visual numeric scale Ն4. Results-The lesions were located mostly in the rostral medulla (rostral 76%, rostralϩmiddle 16%), while ventro-dorsal lesion patterns include ventral (V, 20%), ventralϩmiddle (VM, 33%), and ventralϩmiddleϩdorsal (VMD, 41%

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Section: Discussionmentioning

confidence: 85%

Medial Medullary Infarction

Kim

Han

2009

Stroke

105

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“…Classical triad of MMS consists of ipsilateral lingual paresis, contralateral hemiparesis and deep sensation loss. In addition to these three classical findings, some other clinical signs and symptoms such as headache, vertigo, nausea, vomiting, facial paresis, nystagmus, dysarthria, dysphagia and diplopia may be detected (3,4,8). In the series of Kumral et al (2002), seven of the eleven patients with MMS had classical triad, while Esen et al (2008) detected classical triad in none of the twelve patients (3,4).…”

Section: Discussionmentioning

confidence: 95%

“…They generally develop as a result of occlusion of the intracranial segment of the vertebral artery and cause various clinical pictures. Medial medullary syndrome (MMS) constitutes less than 1% of all ischemic strokes (2)(3)(4). MMS is characterized by ipsilateral hypoglossal paralysis, contralateral hemiplegia and loss of deep sensation.…”

Section: Introductionmentioning

confidence: 99%

An unusual occurance medial medullary syndrome and hemiplegia cruciata; case report

Balal¹,

Aslan²,

Demirkıran³

2018

TÃ¼rk Beyin Damar Hast Derg

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Medial medullary syndrome (MMS) consists of ipsilateral lingual paresis, contralateral hemiparesis and lemniscal sensory loss. Hemiplegia cruciata (HC) consists of ipsilateral arm paresis and contralateral leg paresis. Both syndromes develop as a result of pathologies affecting V4 segment of the vertebral artery and anterior spinal artery. A 54-year-old man was admitted with left sided weakness. Neurological examination revealed left hemiparesis and right lingual paresis. 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. A month later, he developed another stroke causing a newly-emerging right arm paresis and progression of left leg paresis. DWI examination was repeated, which revealed an acute diffusion defect of craniocervical junction extending till third cervical vertebra. The patient was diagnosed with HC following MMS. We presented these two extremely rare syndromes which developed consecutively in a patient with stroke recurrence. Keywords: Medial medullary syndrome, hemiplegia cruciata, vertebrobasilar stroke, recurren stroke. SIRADIŞI BİR BİRLİKTELİK MEDİYAL MEDÜLLER SENDROM VE HEMİPLEJİ CRUCİATA; OLGU SUNUMU ÖZETMediyal medüller sendrom (MMS) ipsilateral dil parezisi, kontralateral hemiparezi ve derin duyu kaybını içerir. Hemipleji cruciata (HC) ise ipsilateral kol parezisi ve kontralateral bacak parezisinden oluşur. Her iki sendrom vertebral arter ve anterior spinal arterin V4 segmentini etkileyen patolojilerin bir sonucu olarak gelişir. 54 yaşında erkek hasta sol yan güçsüzlüğü ile başvurdu. Nörolojik muayenesinde sol hemiparezi ve dil sağ yarımında parezi saptandı. Diffüzyon MRI incelemede medulla oblangatanın anterior bölümünde akut diffüzyon kısıtlılığı saptandı ve MMS olarak tanındı. Bir ay sonra hasta sağ kol parezisi ve sol bacak parezisinde artış sonucu yeni bir inme atağı ile başvurdu. Diffüzyon MRI incelemede kraniyo servikal bileşke ve üçüncü vertebra düzeyinde akut diffüzyon kıstlılığı saptandı. Olgu MMS sonrası inme rekürrensi ile HC olarak tanındı. Bu yazıda inme rekürrensi ile aynı hastada nadir iki sendrom sunulmuştur. Anahtar Sözcükler: Mediyal medüller sendrom, hemipleji cruciata, vertebrobaziller inme, tekrarlayan inme.

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“…Katoh and Kawamoto classified bilateral MMI into type I, with an infarction area from medullary pyramid to pontine medial longitudinal fasciculus and type II with infarction confined to bilateral medullary pyramids [3]. It has generally a poor prognosis [4][5][6]. The vascular events likely to be associated with bilateral MMI are occlusion of vertebral artery or anterior spinal artery and its intrinsic penetrating branches.…”

Section: Discussionmentioning

confidence: 99%

“…The vascular events likely to be associated with bilateral MMI are occlusion of vertebral artery or anterior spinal artery and its intrinsic penetrating branches. The infarcted area usually includes the pyramidal tracts, medial lemniscus, medial longitudinal fasciculus, hypoglossal nucleus or hypoglossal nerve fibres and medullary reticular formation bilaterally [4]. The medulla oblongata has a vast and unique vascular network and its arterial supply arises from the anterior and posterior spinal arteries in addition to the perforating arteries and the long circumferential artery that arise from the basilar or vertebral arteries [7,8].…”

Section: Discussionmentioning

confidence: 99%

Heart in Brain

Tcr¹,

Kanagaraju²,

Akhtar³

et al. 2017

JCR

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Background: Bilateral medial medullary syndrome is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its branches. Clinical diagnosis without neuroimaging is very difficult, the characteristic brain MRI finding of "heart appearance" at DWI has been described in bilateral medial medullary infarct. Case Report: We hereby report 52 year old with acute onset quadriparesis. MRI scan of brain, diffusion weighted (DW) imaging revealed heart shaped hyper-intensity areas in the bilateral medial medulla. Conclusion: MRI with diffusion-weighted imaging helps in timely diagnosis of bilateral MMI in the acute setting and consequently decreasing the possibility of long-term disability.

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Spectrum of medial medullary infarction: clinical and magnetic resonance imaging findings

Cited by 86 publications

References 35 publications

Medial Medullary Infarction

Medial Medullary Infarction

An unusual occurance medial medullary syndrome and hemiplegia cruciata; case report

Heart in Brain

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