Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects.

Kim, J S; Lee, J H; Suh, Dae Chul; Lee, M C

doi:10.1161/01.str.25.7.1405

Cited by 149 publications

(100 citation statements)

References 12 publications

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“…With the use of MRI, it has been demonstrated that in medullary infarction resulting in dysphagia and aspiration, the rostral and dorsolateral parts of the medulla are affected. 4,6,9 A transverse section through the medulla corresponding approximately to the rostral third to fourth of the principal (inferior) olivary nucleus contains the site at which the NTS Interval 0 -2 indicates laryngeal relocation time and the time of pharyngeal phase during swallowing; interval A-C, total duration of SM-EMG; interval A-0, triggering time for the pharyngeal phase of swallowing; amplitude, from peak to baseline in SM-EMG; jitter, the variability of 5 consecutive swallows; and NS, not significant. Values are meanϮSEM.…”

Section: Discussionmentioning

confidence: 99%

“…Occurrences of dysphagia and aspiration have been reported to depend on the site of location of the LMI as detected and correlated by brain stem MRI, 4,9 although the clinical localization and the correlations with the finding on MRI may sometimes be inconsistent. 10,11 However, the MRI findings can demonstrate only the area of the infarct and whether or not the swallowing-related structures, such as NTS and/or NA, are included in the infarct region and, therefore, whether dysphagia would be expected or not.…”

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confidence: 99%

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Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Aydoğdu

Ertekin

Tarlacı

et al. 2001

Stroke

130

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Background and Purpose-We have investigated the pathophysiological mechanisms of dysphagia in Wallenberg's syndrome (WS) that are due to lateral medullary infarction (LMI). Methods-Twenty patients with WS were evaluated by means of clinical and electrophysiological methods that measured the oropharyngeal phase of voluntarily initiated swallowing. For comparison, 22 patients with unilateral hemispheric infarction were investigated during the acute stage of stroke, and 4 patients with unilateral peripheral 9th and 10th cranial nerve palsies were studied. Age-matched 30 healthy control subjects were also included in the study. Results-It was found that dysphagia was clinically more severe in WS patients than in the patients in the other groups.The pharyngeal phase of swallowing was predominantly impaired, whereas in patients with hemispheric stroke, dysphagia was related only to the delay of triggering of the voluntarily induced swallowing. In WS patients, the swallowing reflex was extremely slow in spite of the unilateral involvement due to LMI, whereas the pharyngeal phase of reflex swallowing remained within normal limits in patients with unilateral hemispheric stroke and patients with unilateral peripheral 9th and 10th cranial nerve palsies. Conclusions-Although in WS the lesion due to LMI is unilateral, its effect on oropharyngeal swallowing is bilateral. In LMI, primarily the premotor neurons in the nucleus ambiguus and their connections seem to be affected. Consequently, a disruption and/or disconnection of their linkage to swallowing-related cranial motor neuron pools bilaterally and to the contralateral nucleus ambiguus could produce the swallowing disorders in WS. However, the remaining intact ipsilateral premotor neurons and the contralateral center in the medulla oblongata may eventually begin to operate and overcome the severity and long-term persistence of dysphagia.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Aydoğdu

Ertekin

Tarlacı

et al. 2001

Stroke

130

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“…Patients with infarction predominantly affecting the caudal medulla tend to present with vertigo, nystagmus, and ataxia owing to involvement of vestibular nuclei and cerebellar outflow tracts. 13 More rostral lesions involving the nucleus ambiguus (the motor nucleus of the glossopharyngeal and vagus nerves) may occur and present with severe dysphagia and hoarseness. Rarely, these may be the only presenting complaints.…”

Section: Anatomymentioning

confidence: 99%

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Day

Swartz

Chenkin

et al. 2014

CJEM

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Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla. However, variability in the presentation of this syndrome is the rule, as illustrated in this case presentation and literature review. We propose an approach to diagnosis and management of the lateral medullary syndrome and illustrate the need to integrate clinical information with an understanding of brainstem anatomy with the goal of determining which patients require urgent neuroimaging and acute stroke therapies. The importance of recognition of this condition in the emergency department is underscored by the association between lateral medullary infarction and vertebral artery dissection. With optimal therapy, the prognosis for recovery from lateral medullary syndrome is good. RÉ SUMÉLes patients qui souffrent du syndrome bulbaire laté ral pré sentent gé né ralement des troubles hé misensoriels croisé s, un syndrome de Claude Bernard-Horner homolaté ral et des signes cé ré belleux, manifestations qui ré sultent toutes d'un infarctus du bulbe laté ral. Toutefois, le tableau clinique habituel du syndrome est variable, comme en té moignent un exposé de cas et l'examen de la documentation. Nous ferons donc é tat de l'approche diagnostique et de la prise en charge du syndrome bulbaire laté ral, et soulignerons la né cessité de rassembler tous les renseignements d'ordre clinique et de les mettre en relation avec l'anatomie du tronc cé ré bral afin de distinguer les patients devant subir d'urgence des examens en neuro-imagerie et des traitements pour un accident vasculaire cé ré bral. L'association entre l'infarctus du bulbe laté ral et la dissection de l'artè re verté brale fait ressortir l'importance de reconnaître cette premiè re affection au service des urgences. Moyennant le meilleur traitement possible, le syndrome bulbaire laté ral porte un pronostic favorable quant au ré tablissement.

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“…Gait ataxia may also be related to the initial involvement of the inferior cerebellar peduncle or the spinocerebellar tracts in the medulla. 9 Disappearance of those signs during the course may be explained by the sparing of the most posterolateral portion of the medulla in the definitive lesion (Figure 2). Finally, the absence of sensory impairment in ipsilateral trigeminal districts suggests that the lesion did not involve the most dorsal portion of medulla, where the descending tract and nucleus of the fifth nerve are located (Figure 2 and 3).…”

Section: Discussionmentioning

confidence: 99%

Restricted Dissociated Sensory Loss in a Patient With a Lateral Medullary Syndrome

Cerrato

Imperiale

Bergui

et al. 2000

Stroke

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Background-Various sensory syndromes in lateral medullary infarctions are described. A small variation in the location of a lesion may lead to very different clinical features, owing to the complex anatomy of the medulla oblongata. MRI may identify the location and extent of the ischemic lesions, allowing a clear clinical-anatomical correlation. Case Description-We describe a man with an ischemic lesion in the right portion of the lower medulla that presented a contralateral impairment of spinothalamic sensory modalities and an ipsilateral impairment of lemniscal modalities with a restricted distribution (left forearm and hand, right hand and fingers, respectively). The restricted and dissociated sensory abnormalities represent the only permanent neurological consequence of that lesion. Conclusions-The

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Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects.

Cited by 149 publications

References 12 publications

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review

Restricted Dissociated Sensory Loss in a Patient With a Lateral Medullary Syndrome

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