RESUMEN
We report a patient with hand dystonia related with primary medullary hemorrhage. A 69-year-old man presented with dysarthria, right facial palsy, limb paresthesia, and limb ataxia of acute onset. Neurologic examination revealed abnormal tonic posturing of the right hand and wrist that persisted while at rest. Brain MRI showed acute hemorrhage at the right posteromedial medulla oblongata extending to the upper cervical cord. Ipsilateral limb dystonia might result from the interruption of the reticulospinal tract, sensory or olivocerebellar pathway.
Asunto(s)
Anciano , Humanos , Ataxia , Encéfalo , Disartria , Distonía , Trastornos Distónicos , Extremidades , Parálisis Facial , Mano , Hemorragia , Imagen por Resonancia Magnética , Bulbo Raquídeo , Examen Neurológico , Parestesia , MuñecaRESUMEN
We report a case of isolated primary medullary hemorrhage with a review of the literature to analyze the clinical presentation and radiological character. A 46-year-old man with chronic alcoholism developed tegmental medullary syndrome secondary to spontaneous hemorrhages in the medulla oblongata. Magnetic resonance imaging study was carried out on the third day after the second event, which showed two distinct isolated hematomas in the medulla oblongata. Digital subtraction angiography was normal. The cause of hemorrhage was presumed to be cryptic vascular malformation. The primary medullary hemorrhage usually presents with a characteristic syndrome of sudden onset vertigo with neurological signs that correspond to various combination of medial and lateral medullary involvement. Usually, the prognosis is good only with conservative treatment.