A Case of Medullary Infarct Causing Central Alveolar Hypoventilation

Lim, William; Breitling, May; Nugent, Bryan; Sinha, Aditi; Diaz, Keith

doi:10.7759/cureus.17153

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…The lateral medulla oblongata contains the nucleus tractus solitarius, nucleus suspectus, and reticular formation related to swallowing function and respiratory neurons and pre-Bötzinger complex related to respiratory function [ 11 ]. These nerve nuclei are anatomically adjacent to the medial medulla oblongata, and extensive ischemia in the medial medulla oblongata can cause dysphagia and respiratory impairment [ 12 ]. Therefore, BMMI with respiratory failure and dysphagia should be considered to represent a severe stroke.…”

Section: Discussionmentioning

confidence: 99%

Role of Acute Physiotherapy in Bilateral Medial Medullary Infarction: A Case Report

Miyashita,

Tsushima,

Nagamine

2024

Cureus

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Bilateral medial medullary infarction (BMMI) is a rare stroke syndrome, which frequently has poor clinical outcomes. Reports on physical therapy for BMMI are few because of its poor prognosis. Therefore, this report aims to present a patient who developed BMMI and underwent well-considered rehabilitation. A 67-year-old man presented to our clinic with an acute onset of vomiting and dizziness. Magnetic resonance imaging (MRI) showed no abnormal signal intensity, and the patient was admitted for peripheral dizziness. On day two, he developed quadriplegia, bulbar palsy, and respiratory impairment, such as prolonged apnea. A second MRI revealed a high-intensity lesion in the bilateral medial medulla oblongata. He was diagnosed with BMMI, and rehabilitation treatment was initiated. On day 16, his sputum volume increased, and he could not expectorate effectively due to decreased coughing ability. Therefore, mechanical insufflation-exsufflation (MI-E) was performed to improve his airway clearance. On day 21, he developed aspiration pneumonia (AP), which became severe and led to acute respiratory failure. Nasal airway intubation and oxygen flow of 5 L/minute were initiated. His respiratory function was not seriously aggravated, and recurrent AP was prevented with the application of respiratory physiotherapy procedures, such as postural drainage, in collaboration with other medical staff, and MI-E. On day 60, the patient was transferred to the recovery phase rehabilitation ward. BMMI tends to worsen swallowing disorders progressively and is associated with a high risk of severe AP. Providing physiotherapy in the acute phase is important to reduce the risk of serious illness.

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Section: Discussionmentioning

confidence: 99%

Role of Acute Physiotherapy in Bilateral Medial Medullary Infarction: A Case Report

Miyashita,

Tsushima,

Nagamine

2024

Cureus

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Opalski syndrome: A comprehensive systematic review of cases

Rezaei Zadeh Rukerd,

Mirkamali,

Alizadeh

2024

Clinical Neurology and Neurosurgery

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Opalski Syndrome: An Intricate Case of Lateral Medullary Infarction With Unconventional Neurological Features and Diagnostic Challenges

Sharma,

Duhan

et al. 2024

Cureus

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Opalski syndrome is a rare variant of Wallenberg syndrome characterized by ipsilateral hemiparesis. We present a case involving a 50-year-old male who exhibited symptoms of right-sided upper and lower limb weakness, dizziness, and ataxia. T2-weighted magnetic resonance imaging (MRI) identified an infarction in the right lateral medulla. This case displayed several unique and atypical features, including the negative Babinski sign, absence of dysphagia, and dysarthria. The diagnosis was confirmed through meticulous clinical examination and advanced radiological investigations, such as MRI. This case report underscores the critical importance of thorough clinical evaluation and the correlation of findings with radiological investigations to reduce morbidity and mortality in patients with Opalski syndrome.

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A Case of Medullary Infarct Causing Central Alveolar Hypoventilation

Cited by 3 publications

References 15 publications

Role of Acute Physiotherapy in Bilateral Medial Medullary Infarction: A Case Report

Role of Acute Physiotherapy in Bilateral Medial Medullary Infarction: A Case Report

Opalski syndrome: A comprehensive systematic review of cases

Opalski Syndrome: An Intricate Case of Lateral Medullary Infarction With Unconventional Neurological Features and Diagnostic Challenges

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