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(Stroke. 2009;40:3221.)
© 2009 American Heart Association, Inc.

Original Contributions

Medial Medullary Infarction

Clinical, Imaging, and Outcome Study in 86 Consecutive Patients

Jong S. Kim, MD, PhD Young S. Han, MD

From the Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea.

Correspondence to Jong S. Kim, MD, PhD, Stroke Center and Department of Neurology, Asan Medical Center, Song-Pa PO Box 145, Seoul 138-600, South Korea. E-mail jongskim{at}amc.seoul.kr

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 >3), were assessed by telephone interview. Central poststroke pain (CPSP) was defined as persistent pain with visual numeric scale 4.

Results— The lesions were located mostly in the rostral medulla (rostral 76%, rostral+middle 16%), while ventro-dorsal lesion patterns include ventral (V, 20%), ventral+middle (VM, 33%), and ventral+middle+dorsal (VMD, 41%). Clinical manifestations included motor dysfunction in 78 patients (91%), sensory dysfunction in 59 (73%), and vertigo/dizziness in 51 (59%), each closely related to involvement of ventral, middle, and dorsal portions, respectively (P<0.001, each). Vertebral artery (VA) atherosclerotic disease relevant to the infarction occurred in 53 (62%) patients, mostly producing atheromatous branch occlusion (ABO). Small vessel disease (SVD) occurred in 24 (28%) patients. ABO was more closely related to VMD (versus V+VM) than was SVD (P=0.035). During follow-up (mean 71 months), 11 patients died, and recurrent strokes occurred in 11. Old age (P=0.001) and severe motor dysfunction at admission (P=0.001) were factors predicting poor prognosis. CPSP, occurring in 21 patients, was closely (P=0.013) related to poor clinical outcome.

Conclusion— MMI usually presents with a rostral medullary lesion, with a good clinical ventro-dorsal imaging correlation, caused most frequently by ABO followed by SVD. A significant proportion of patients remain dependent or have CPSP.

Key Words: medulla oblongata • medial medullary infarction • MRI • central poststroke pain