This Article Full Text Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kim, J. S. Articles by Chung, C. S. Search for Related Content PubMed PubMed Citation Articles by Kim, J. S. Articles by Chung, C. S.

(Stroke. 1995;26:1548-1552.)
© 1995 American Heart Association, Inc.

Articles

Medial Medullary Syndrome

Report of 18 New Patients and a Review of the Literature

Presented in part at the 4th European Stroke Conference, Bordeaux, France, June 1-3, 1995.

Jong Sung Kim, MD; Hyeon Gak Kim, MD Chin Sang Chung, MD

From the Department of Neurology, University of Ulsan, Asan Medical Center, Seoul (J.S.K., H.G.K.), and Department of Neurology, Chungnam National University Hospital, Taejon (C.S.C.), South Korea.

Correspondence to Jong S. Kim, MD, Department of Neurology, Asan Medical Center, Song-pa PO Box 145, Seoul 138-600, South Korea.

Background and Purpose With advanced imaging techniques, infarctions occurring in the medulla are now more easily identified. To date, however, only approximately 30 cases of medial medullary infarction syndrome (MMS) have been reported, and the clinical and radiological characteristics of MMS remain to be studied.

Methods We studied 18 patients (15 men, 3 women; mean age, 62 years) who had compatible clinical and MRI findings of MMS and reviewed the previously reported cases.

Results Seventeen patients had a unilateral lesion usually involving the upper medulla, and 1 had bilateral lesions. Fifteen patients had unilateral sensorimotor stroke, while 2 presented with pure motor stroke. The face was usually but not always spared. The degree of hemiparesis varied, and a tingling sensation with decreased vibration and position sense was the most common sensory manifestation. Two patients had lingual paresis, and none suffered respiratory difficulties. One patient presented with bilateral gait ataxia without sensorimotor dysfunction. Angiography or MR angiography performed in 9 patients showed vertebral artery disease in 6. Three patients had concurrent lateral medullary infarction, and 1 had a previous history of lateral medullary syndrome. The prognosis was generally good, although residual hemiparesis remained in patients with initially severe hemiparesis. Review of 26 previously reported cases showed that they frequently had bilateral lesions, often presenting with quadriplegia, lingual paresis, respiratory symptoms, and a grave prognosis.

Conclusions Our data illustrate that MMS is most often manifested as benign hemisensorimotor stroke frequently associated with tingling sensation and impaired deep sensation. This benign form of MMS should be much more common than MMS with poor prognosis and may have been frequently misdiagnosed as capsular or pontine stroke before the era of MRI.

Key Words: cerebral infarction • magnetic resonance imaging • medulla oblongata

This article has been cited by other articles:

				J. S. Kim and Y. S. Han Medial Medullary Infarction: Clinical, Imaging, and Outcome Study in 86 Consecutive Patients Stroke, October 1, 2009; 40(10): 3221 - 3225. [Abstract] [Full Text] [PDF]

				J. S. Kim, K. -D. Choi, S. -Y. Oh, S. -H. Park, M. -K. Han, B. -W. Yoon, and J. -K. Roh Medial medullary infarction: Abnormal ocular motor findings Neurology, October 25, 2005; 65(8): 1294 - 1298. [Abstract] [Full Text] [PDF]

				M. Kwon, J. H. Lee, and J. S. Kim Dysphagia in unilateral medullary infarction: Lateral vs medial lesions Neurology, September 13, 2005; 65(5): 714 - 718. [Abstract] [Full Text] [PDF]

				M Nakajima, M Inoue, and Y Sakai Contralateral pharyngeal paralysis caused by medial medullary infarction J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1292 - 1293. [Abstract] [Full Text] [PDF]

				P. Zickler, R. J. Seitz, H.-P. Hartung, and H. Hefter Bilateral medullary pyramid infarction Neurology, May 24, 2005; 64(10): 1801 - 1801. [Full Text] [PDF]

				W. Kameda, T. Kawanami, K. Kurita, M. Daimon, T. Kayama, T. Hosoya, T. Kato, and for the Study Group of the Association of Cerebrov Lateral and Medial Medullary Infarction: A Comparative Analysis of 214 Patients Stroke, March 1, 2004; 35(3): 694 - 699. [Abstract] [Full Text] [PDF]

				H.-C. Fung, S.-T. Chen, L.-M. Tang, and L.-S. Ro Triparesis: MRI documentation of bipyramidal medullary infarction Neurology, April 9, 2002; 58(7): 1130 - 1130. [Full Text] [PDF]

				P. P. Urban, S. Wicht, G. Vucorevic, S. Fitzek, J. Marx, F. Thomke, A. Mika-Gruttner, C. Fitzek, P. Stoeter, and H. C. Hopf The course of corticofacial projections in the human brainstem Brain, September 1, 2001; 124(9): 1866 - 1876. [Abstract] [Full Text] [PDF]

				S.-H. Lee, D.-E. Kim, E.-C. Song, and J.-K. Roh Sensory Dermatomal Representation in the Medial Lemniscus Arch Neurol, April 1, 2001; 58(4): 649 - 651. [Abstract] [Full Text] [PDF]

				H. Kim, C.-S. Chung, K.-H. Lee, and J. Robbins Aspiration Subsequent to a Pure Medullary Infarction: Lesion Sites, Clinical Variables, and Outcome Arch Neurol, April 1, 2000; 57(4): 478 - 483. [Abstract] [Full Text] [PDF]

				J. S. Kim and S. Choi-Kwon Sensory Sequelae of Medullary Infarction : Differences Between Lateral and Medial Medullary Syndrome Stroke, December 1, 1999; 30(12): 2697 - 2703. [Abstract] [Full Text] [PDF]

				S TERAO, M IZUMI, S TAKATSU, J TAKAGI, T MITSUMA, A TAKEDA, M HIRAYAMA, and G SOBUE Serial magnetic resonance imaging shows separate medial and lateral medullary infarctions resulting in the hemimedullary syndrome J. Neurol. Neurosurg. Psychiatry, July 1, 1998; 65(1): 134a - 135. [Full Text]

				J. S. Kim, J. H. Lee, and C. G. Choi Patterns of Lateral Medullary Infarction : Vascular Lesion–Magnetic Resonance Imaging Correlation of 34 Cases Stroke, March 1, 1998; 29(3): 645 - 652. [Abstract] [Full Text] [PDF]

				S Terao, S Takatsu, M Izumi, J Takagi, T Mitsuma, A Takahashi, A Takeda, and G Sobue Central facial weakness due to medial medullary infarction: the course of facial corticobulbar fibres J. Neurol. Neurosurg. Psychiatry, September 1, 1997; 63(3): 391 - 393. [Abstract] [Full Text] [PDF]

				J. S. Kim and Y. H. Bae Pure or Predominant Sensory Stroke Due to Brain Stem Lesion Stroke, September 1, 1997; 28(9): 1761 - 1764. [Abstract] [Full Text]

				J. R. Keane Twelfth-Nerve Palsy: Analysis of 100 Cases Arch Neurol, June 1, 1996; 53(6): 561 - 566. [Abstract] [PDF]

				J. S. Kim and S. Choi-Kwon Discriminative Sensory Dysfunction After Unilateral Stroke Stroke, April 1, 1996; 27(4): 677 - 682. [Abstract] [Full Text]