![]() Majority of patient with bilateral medial medullary stroke who survivors remained dependent.Įxtracranial vertebral artery (ECVA), Intracranial vertebral artery (ICVA), Posterior cerebral artery (PCA), Lower motor neuron (LMN), Medial research council (MRC) GBS and Neuromuscular disorders are important differential of bilateral medial medullary stroke presenting triad of bulbar symptoms, quadriparesis and respiratory failure. This case study may help in early recognition of this type of stroke presenting with triad of bulbar symptoms, quadriparesis and respiratory failure.Ĭonclusion: Bilateral medial medullary stroke is very rare stroke. He was shifted to rehabilitation center and discharged to home with modified rankin scale of 2/6.ĭiscussion: Medial medullary infraction is < 1% of vertebrobasilar strokes and bilateral stroke is very rare. Patient CSF analysis and viral HSV-PCR was normal. MRI head showed bilateral medial medullary acute infarct ("heart shape sign") and occlusion of left distal vertebral artery V4 segment. Method: 50-year-old gentleman presented with acute vertigo, vomiting, bulbar symptoms, quadriparesis, respiratory failure and obtunded. The characteristic MRI finding of "heart shape sign" at DWI has been described. Bilateral medial medullary stroke is a very rare. The most frequent finding in patients with PCA territory infarction is a hemianopia. Occlusion of the rostral portion of the basilar artery can cause ischemia of the midbrain, thalami, temporal, and occipital lobe. Basilar artery occlusive disease most often presents as ischemia in the pons. The most common location of atherosclerotic occlusive disease within the posterior circulation is the proximal portion of the vertebral artery in the neck within the first inches. The most common causes of posterior circulation large artery ischemia are atherosclerosis, embolism, and dissection. Secondary persistent or recurrent facial ulcerationī.Introduction: 20% of ischemic strokes involve posterior circulation. May be associated with Wallenburg's syndrome and is a rare cause of facial ulcerations associated with injury to the trigeminal nerve (Parimalam 2014) with the syndrome comprised of triad ofģ. involvement of central tegmental tract: palatal myoclonusĪ.involvement of Deiters' nucleus and other vestibular nuclei: nystagmus and vertigo.involvement of hypthalamic fibers: sympathetic nervous system abnormal c/w Horners syndrome.involvement of spinothalamic tract: loss of pain and temperature sensation to the opposite side of body.involvement of trigeminal nucleus: ipsilateral facial and corneal anesthesia.laryngeal, pharyngeal and palatal paralysis.involvement of nucleus ambiguus: dysphagia, dysphonia and dysarthria.Vertebral artery dissection associated with:.Hypertension is most common risk factor with other causes.Most commonly caused by atherothrombotic occlusion of the vertebral artery (then posterior inferior cerebellar arteray and least often the medullary arteries.Estimated 60,000 new cases in the United States each year with usually a better outcome - with most common sequelae being gait instability and most patients returning to satisfactory activities of daily living(Lui 2019). A complete Wallenberg syndrome is not common with key factors in clinical diagnosis being 'crossed hemiparesis or hemianesthesia' indicating a brainstem lesionĥ. may also be associated with obstructive sleep apnea and airway obstruction (Vaidyanathan 2007)Ĥ.Otolaryngological features include dysphonia, dysphagia and nasal regurgitation related to.Clinical symptoms include difficulty swallowing, slurred speech, facial pain, vertigo, Horner syndrome, and possibly palatal myoclonus.loss of pain and temperature sensation on the ipsilateral (same) side of the face.Sensory deficits affecting the face and cranial nerves on the same side with the infarct.loss of pain and temperature sensation on the contralateral (opposite) side of the body.Sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction.Constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain.Wallenberg syndrome = Lateral medullary syndrome (aka 'PICA' syndrome Posterior Inferior Cerebellar Artery syndrome) Return to: Unilateral Laryngeal Paralysis or Vocal Cord Paralysis see: Tapia Syndrome paralysis of vagus and hypoglossal nerves after intubation Wallenberg Syndrome (PICA Syndrome or Lateral Medullary Infaction)
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