Medial Medullary Syndrome: Clinical Study of 9 Cases

ABSTRACT

BACKGROUND AND PURPOSE: Medial medullary syndrome (MMS) is characterized clinically by a triad of ipsilateral hypoglossal nerve palsy, contralateral or ipsilateral hemiparesis sparing the face, and sensory disturbance of position and/or vibration. However, this syndrome is quite rare, and its clinical and radiological findings have not yet been clearly characterized. METHODS: We reviewed 9 patients with AMS who were diagnosed based on their clinical and magnetic resonance imaging (MRI) findings. RESULTS: There were 8 men and I woman with average age of 60 (41 to 75) years. The risk factors included hypertension in 8, DM in 6, cigarette smoking in 4, hypercholesterolemia in 4, gout in I and atrial fibrillation with LV dysfunction in 1. Their, clinical findings included contralateral hemiparesis in 9 and contralateral hermhypesthesia in & Only one patient presented with ipsilateral lingual paresis. The motor weakness was mild in 5 and moderate in 4. MRI results showed the lesions were located in the upper medulla in 7 and lower medulla in 2. Alteration of vertebral artery flow signal void in MRI was observed in 6 patients. Three patients had additional infarcts in the lateral medullary area. Prognosis of the motor weakness was good in 5 and stationary in 4. CONCLUSION: Our patients generally presented with unilateral sensorimotor stroke. Ipsilateral h6miparesis and tongue weakness, unique signs of @, were found only rarely, and the absence of these findings often made it difficult to localize the lesion by clinical judgement only.