Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-23T04:58:07.376Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  04 March 2015

Gregory S. Day ,
Richard H. Swartz ,
Jordan Chenkin ,
Adil I. Shamji  and
David W. Frost
Gregory S. Day*
Affiliation:
Division of Neurology, Department of Medicine, University of Toronto University Health Network Hospitals
Richard H. Swartz
Affiliation:
Division of Neurology, Department of Medicine, University of Toronto Sunnybrook Health Sciences Centre
Jordan Chenkin
Affiliation:
Sunnybrook Health Sciences Centre Division of Emergency Medicine, Department of Medicine, University of Toronto
Adil I. Shamji
Affiliation:
Department of Family and Community Medicine, University of Toronto
David W. Frost
Affiliation:
University Health Network Hospitals Division of General Internal Medicine, Department of Medicine, University of Toronto Herbert HoPingKong Centre for Excellence in Education and Practice, University of Toronto, Toronto, ON
*
Division of Neurology, University of Toronto, Toronto Western Hospital, 399 Bathurst Street, Toronto, ON M5T 2S8; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

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.

Keywords

lateral medullary infarctlateral medullary syndromeposterior fossastrokevertebral artery dissectionWallenberg syndrome
Type
Case Report • Rapport De Cas
Information
Canadian Journal of Emergency Medicine , Volume 16 , Issue 2 , March 2014 , pp. 164 - 170
Copyright
Copyright © Canadian Association of Emergency Physicians 2014

References

REFERENCES

1. Currier, RD, Giles, CL, DeJong, RN. Some comments on Wallenberg’s lateral medullary syndrome. Neurology 1961;11:778–91, doi:10.1212/WNL.11.9.778.Google Scholar
2. Lee, MJ, Park, YG, Kim, SJ, et al. Characteristics of stroke mechanisms in patients withmedullary infarction. Eur J Neurol 2012;19:1433–9, doi:10.1111/j.1468-1331.2012.03722.x.Google Scholar
3. Kim, JS. Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients. Brain 2003;126(Pt 8):1864–72, doi:10.1093/brain/awg169.Google Scholar
4. van Swieten, JC, Koudstaal, PJ, Visser, MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–7, doi:10.1161/01.STR.19.5.604.Google Scholar
5. Sacco, RL, Freddo, L, Bello, JA, et al. Wallenberg’s lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol 1993;50:609–14, doi:10.1001/archneur.1993.00540060049016.Google Scholar
6. Baugh, CW, Brown, DF, Nadel, ES. Horner’s syndrome, hoarseness, and unsteady gait. J Emerg Med 2009;36:176–80, doi:10.1016/j.jemermed.2008.12.015.Google Scholar
7. Kameda, W, Kawanami, T, Kurita, K, et al. Lateral and medial medullary infarction: a comparative analysis of 214 patients. Stroke 2004;35:694–9, doi:10.1161/01.STR.0000117570.41153.35.Google Scholar
8. Fukuoka, T, Takeda, H, Dembo, T, et al. Clinical review of 37 patients with medullary infarction. J Stroke Cerebrovasc Dis 2012;21:594–9, doi:10.1016/j.jstrokecerebrovasdis.2011.01.008.Google Scholar
9. Caplan, L. Posterior circulation ischemia: then, now and tomorrow. Stroke 2000;31:2011–23, doi:10.1161/01.STR.31.8.2011.Google Scholar
10. Kratz, SN, Butler, KH. Vertebral artery dissection presenting as acute cerebrovascular accident. J Emerg Med 2011;40:151–7, doi:10.1016/j.jemermed.2007.11.039.Google Scholar
11. Ernst, E. Life-threatening complications of spinal manipulation. Stroke 2001;32:809–10, doi:10.1161/01.STR.32.3.809.Google Scholar
12. Caplan, L, Chung, CS, Wityk, R, et al. New England Medical Center Posterior Circulation Stroke Registry: I. Methods, data base, distribution of brain lesions, stroke mechanisms, and outcomes. J Clin Neurol 2005;1:14–30, doi:10.3988/jcn.2005.1.1.14.Google Scholar
13. Kim, J, Lee, J, Suh, D, et al. Spectrum of lateral medullary syndrome. Correlation between clinical findings and magnetic resonance imaging in 33 subjects. Stroke 1994;25:1405–10, doi:10.1161/01.STR.25.7.1405.Google Scholar
14. Tarnutzer, AA, Berkowitz, AL, Robinson, KA, et al. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011;183:E571–91, doi:10.1503/cmaj.100174.Google Scholar
15. Kattah, JC, Talkad, AV, Wang, DZ, et al. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009;40:3504–10, doi:10.1161/STROKEAHA.109.551234.Google Scholar
16. National Institute of Neurological Disorders and Stroke rtPA Stroke Sudy Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581–7, doi:10.1056/NEJM199512143332401.Google Scholar
17. Hopyan, JJ, Gladstone, DJ, Mallia, G, et al. Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol 2008;29:1826–30, doi:10.3174/ajnr.A1257.Google Scholar
18. Hwang, DY, Silva, GS, Furie, KL, et al. Comparative sensitivity of computed tomography vs. magnetic resonance imaging for detecting acute posterior fossa infarct. J Emerg Med 2012;42:559–65, doi:10.1016/j.jemermed.2011.05.101.Google Scholar
19. Chalela, JA, Kidwell, CS, Nentwich, LM, et al. Magnetic resonance imaging and computed tomography in emergencyassessment of patients with suspected acute stroke: a prospective comparison. Lancet 2007;369:293–8, doi:10.1016/S0140-6736(07)60151-2.Google Scholar
20. Lindsay, MP, Gubitz, G, Bayley, M, et al., Canadian best practice recommendations for stroke care (update 2010). On behalf of the Canadian Stroke Strategy Best Practices and Standards Writing Group. Ottawa: Canadian Stroke Network; 2010.Google Scholar
21. Engelter, ST, Rutgers, MP, Hatz, F, et al. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke 2009;40:3772–6, doi:10.1161/STROKEAHA.109.555953.Google Scholar
22. CAST (Chinese Acute Stroke Trial) Collaborative Group. CAST: randomised placebo-controlled trial of early aspirin use in 20 000 patients with acute ischaemic stroke. Lancet 1997;349:1641–9, doi:10.1016/S0140-6736(97)04010-5.Google Scholar
23. Nelles, G, Contois, KA, Valente, SL, et al. Recovery following lateral medullary infarction. Neurology 1998;50:1418–22, doi:10.1212/WNL.50.5.1418.Google Scholar
24. Stewart, P, Agur, A, Leibgott, B, et al. Functional neuroanatomy atlas. Toronto: The Functional Neuroanatomy Group, University of Toronto; 2003.Google Scholar