Skip to main content
Log in

The medullary vascular syndromes revisited

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

Abstract

There are two major vascular syndromes of the medulla oblongata: the medial and the lateral. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. Lateral medullary infarction commonly presents with Homer's syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. Combinations of the two major syndromes occur as bilateral medial medullary, hemi-medullary and bilateral lateral medullary syndromes. Each of these syndromes frequently manifests with incomplete or atypical findings depending on the extent of the lesion. Magnetic resonance imaging has been useful in the clinical diagnosis of medullary infarctions. The site of the lesion may help predict the arteries involved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Babinski J, Nageotte J (1902) Hemiasynergie, lateropulsion et myosis bulbaires avec hemianesthesie et hemiplegie croisees. Rev Neurol (Paris) 10:358–365

    Google Scholar 

  2. Balch RW, Spooner JW (1981) Downbeat nystagmus: a type of central vestibular nystagmus. Neurology 31:304–310

    Google Scholar 

  3. Bogousslavsky J, Khurana R, Deruaz JP, et al. (1990) Respiratory failure and unilateral caudal brainstem infarction. Ann Neurol 28:668–673

    Google Scholar 

  4. Bogousslavsky J, Regli F, Maeder P, et al (1993) The etiology of posterior circulation infarcts: a prospective study using magnetic resonance imaging and magnetic resonance angiography. Neurology 43:1528–1533

    Google Scholar 

  5. Bucy PC, Keplinger JE, Siqueira EB (1964) Destruction of the “pyramidal tract” in man. J Neurosurg 21:385–398

    Google Scholar 

  6. Caplan LR (1983) Bilateral distal vertebral artery occlusion. Neurology 33:552–558

    Google Scholar 

  7. Caplan LR (1988) Vertebrobasilar system syndromes. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 53. Elsevier, New York, pp 371–408

    Google Scholar 

  8. Caplan LR, Zarins CK, Hemmati M (1985) Spontaneous dissection of the extracranial vertebral arteries. Stroke 16:1030–1038

    Google Scholar 

  9. Chokroverty S, Rubino FA, Haller C (1975) Pure motor hemiplegia due to pyramidal infarction. Arch Neurol 32:647–648

    Google Scholar 

  10. Currier RD (1969) Syndromes of the medulla oblongata. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 2. North-Holland, New York, pp 217–237

    Google Scholar 

  11. Currier RD (1976) The medial medullary syndrome. J Univ Mich Med Center 42:96–104

    Google Scholar 

  12. Davison C (1944) Syndrome of the anterior spinal artery of the medulla oblongata. J Neuropathol Exp Neurol 3:73–80

    Google Scholar 

  13. Dejerine J (1914) Semiologie des affections du systeme nerveux. Masson, Paris, pp 226–230

    Google Scholar 

  14. Devereaux MW, Keane JR, Davis RL (1973) Automatic respiratory failure associated with infarction of the medulla. Arch Neurol 29:46–52

    Google Scholar 

  15. Fisher CM, Karnes WE, Kubik CS (1961) Lateral medullary infarction — the pattern of vascular occlusion. J Neuropathol Exp Neurol 20:323–379

    Google Scholar 

  16. Fox AJ, Bogousslavsky J, Carey LS, et al (1986) Magnetic resonance imaging of small medullary infarcts. AJNR 7:229–233

    Google Scholar 

  17. Gillilan LA (1964) The correlation of the blood supply to the human brain stem with clinical brain stem lesions. J Neuropathol Exp Neurol 23:78–108

    Google Scholar 

  18. Ho KL, Meyer KR (1981) The medial medullary syndrome. Arch Neurol 38:385–387

    Google Scholar 

  19. Jagiella WM, Sung JH (1989) Bilateral infarction of the medullary pyramids in humans. Neurology 39:21–24

    Google Scholar 

  20. Kase CS, Varakis JN, Stafford JR, Mohr JP (1983) Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery. Stroke 14:413–418

    Google Scholar 

  21. Kleinert G, Fazekas F, Kleinert R, et al (1993) Bilateral medial medullary infarction: magnetic resonance imaging and correlative histopathologic findings. Eur Neurol 33:74–76

    Google Scholar 

  22. Krayenbuhl H, Yasargil G (1957) Der subtentorielle Kollateralkreislauf im angiographischen Bild. Ein pathogenetischer Beitrag zur Klinik der vascularen bulbopontinen Syndrome. Dtsch Z Nervenheilkd 177:103–116

    Google Scholar 

  23. Lazorthes G, Poulhes J, Bastide G, et al (1958) Les territoires arteriels du tronc cerebral. Recherches anatomiques et syndromes vasculaires. Presse Med 66:2048–2051

    Google Scholar 

  24. Leestma JE, Noronha A (1976) Pure motor hemiplegia, medullary pyramid lesion, and olivary hypertrophy. J Neurol Neurosurg Psychiatry 39:877–884

    Google Scholar 

  25. Levin BE, Margolis G (1977) Acute failure of automatic respiration secondary to a unilateral brainstem infarct. Ann Neurol 1:583–586

    Google Scholar 

  26. Mizutani T, Lewis RA, Gonatas NK (1980) Medial medullary syndrome in a drug abuser. Arch Neurol 37:425–428

    Google Scholar 

  27. Mossuto-Agatiello L, Kniahynicki C (1990) The hemimedullary syndrome: case report and review of the literature. J Neurol 237:208–212

    Google Scholar 

  28. Nishiyama K, Fuse S, Shimizu J, et al (1992) A case of fibromuscular dysplasia presenting with Wallenberg syndrome and developing a giant aneurysm of the internal carotid artery in the cavernous sinus. Rinsho Shinkeigaku 32:1117–1120

    Google Scholar 

  29. Reinhold H (1894) Beiträge zur Pathologie der acuten Erweichungen des Pons und der Oblongata. Zugleich ein Beitrag zur Lehre von der “Bulbaren Ataxie”. Dtsch Z Nervenheilkd 5:351–374

    Google Scholar 

  30. Romano J, Merritt HH (1941) The singular affection of Gaspard Vieusseux: an early description of the lateral medullary syndrome. Bull Hist Med 9:72–79

    Google Scholar 

  31. Ropper AH, Fischer CM, Kleinman GM (1979) Pyramidal infarction in the medulla: a cause of pure motor hemiplegia sparing the face. Neurology 29:91–95

    Google Scholar 

  32. Ross MA, Biller J, Adams HP Jr, Dunn V (1986) Magnetic resonance imaging in Wallenberg's lateral medullary syndrome. Stroke 17:542–545

    Google Scholar 

  33. Sacco RL, Freddo L, Bello JA, et al (1993) Wallenberg's lateral medullary syndrome: clinical-magnetic resonance imaging correlations. Arch Neurol 50:609–614

    Google Scholar 

  34. Sawada H, Seriu N, Udaka F, et al (1990) Magnetic resonance imaging of medial medullary infarction. Stroke 21:963–966

    Google Scholar 

  35. Spiller WG (1908) The symptom-complex of a lesion of the uppermost portion of the anterior spinal and adjoining portion of the vertebral arteries. J Nerv Ment Dis 35:775–778

    Google Scholar 

  36. Stopford JSB (1916) The arteries of the pons and medulla oblongata. J Anat Physiol 50:131–164 and 255–280

    Google Scholar 

  37. Toyoda K, Hasegawa Y, Yonehara T, et al (1992) Bilateral medial medullary infarction with oculomotor disorders. Stroke 23:1657–1659

    Google Scholar 

  38. Trelles JO, Trelles L, Urquiaga C (1973) Le remollissement median du bulbe. A propos de deux cas anatomocliniques. Rev Neurol (Paris) 129:91–104

    Google Scholar 

  39. Wallenberg A (1895) Acute Bulbaraffection (Embolie der Art. cerebellar post. inf. sinistr.). Arch Psychiatr Nervenkr 27:504–540

    Google Scholar 

  40. Wallenberg A (1901) Anatomischer Befund in einem als “Acute Bulbaraffection” (Embolie der Art. cerebellar post. inf. sinistr.) beschriebenen Falle. Arch Psychiatr Nervenkr 34:923–959

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gan, R., Noronha, A. The medullary vascular syndromes revisited. J Neurol 242, 195–202 (1995). https://doi.org/10.1007/BF00919591

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00919591

Key words

Navigation