두 번의 연속적 뇌경색에 의한 Hemimedulla 증후군
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Background : Two major vascular syndromes of the medulla oblongata are the medial and lateral medullary syndrome. Combination of the two syndromes may occur by obstruction of vertebral artery, but the report about hemimedullary syndrome caused by consecutive infarction with its MRI scan is rare. Case report : 1st admission; A 59-year-old hypertensive man developed abrupt weakness and tingling sensation of his right limb. He also noted dizziness and speech disturbances. On neurologic examination, he had dysarthria, nystagmus, left hypoglossal nerve palsy, and right hemiparesis without facial weakness. Carotid doppler sonography results showed findings suggestive of occlusion of the left vertebral artery. Brain MRI revealed left anteromedial medullary lesion. 2nd admission (after 1 month); The patient our hospital again because of newly developed hoarseness, tingling sensation of the left face, and recurrent right hemiparesis. Neurologic examinations revealed dysarthria, vocal cord paralysis, Honer’s syndrome, nystagmus, facial palsy and hypesthesia, absent gag reflex, hypoglossal nerve palsy, cerebellar ataxia on the left side, and hemiparesis, and sensory disturbance on the right hemibody. Repeat brain MRI revealed left hemimedullary infarction. Conclusion : Hemimedullary syndrome may be caused by two consecutive medullary infarcts. Korean Journal of Stroke 2000;2(1): 103~107
Abstract
Background : Two major vascular syndromes of the medulla oblongata are the medial and lateral medullary syndrome. Combination of the two syndromes may occur by obstruction of vertebral artery, but the report about hemimedullary syndrome caused by consecutive infarction with its MRI scan is rare. Case report : 1st admission; A 59-year-old hypertensive man developed abrupt weakness and tingling sensation of his right limb. He also noted dizziness and speech disturbances. On neurologic examination, he had dysarthria, nystagmus, left hypoglossal nerve palsy, and right hemiparesis without facial weakness. Carotid doppler sonography results showed findings suggestive of occlusion of the left vertebral artery. Brain MRI revealed left anteromedial medullary lesion. 2nd admission (after 1 month); The patient our hospital again because of newly developed hoarseness, tingling sensation of the left face, and recurrent right hemiparesis. Neurologic examinations revealed dysarthria, vocal cord paralysis, Honer’s syndrome, nystagmus, facial palsy and hypesthesia, absent gag reflex, hypoglossal nerve palsy, cerebellar ataxia on the left side, and hemiparesis, and sensory disturbance on the right hemibody. Repeat brain MRI revealed left hemimedullary infarction. Conclusion : Hemimedullary syndrome may be caused by two consecutive medullary infarcts. Korean Journal of Stroke 2000;2(1): 103~107