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NEUROLOGY 1996;47:1141-1147
© 1996 American Academy of Neurology

Medial medullary infarction

Analyses of eleven patients

K. Toyoda, MD, T. Imamura, MD, Y. Saku, MD, J. Oita, MD, S. Ibayashi, MD, K. Minematsu, MD, T. Yamaguchi, MD and M. Fujishima, MD

From the Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Fukuoka, Japan (Drs. Toyoda, Ibayashi, and Fujishima), the Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Suita, Japan (Drs. Imamura, Oita, Minematsu, and Yamaguchi), and the Department of Cerebrovascular Disease, Institute of Neuroscience, St. Mary's Hospital, Kurume, Japan (Dr. Saku).
Received November 7, 1995. Accepted in final form April 12, 1996.
Address correspondence and reprint requests to Dr. Kazunori Toyoda, Second Department of Internal Medicine, Faculty of Medicine, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-82, Japan.

Of 2,130 consecutive patients admitted to two hospitals with acute brain infarction, we examined 11 patients (0.52%) with medial medullary infarction. The infarcts documented by MRI were unilateral in 9 patients and bilateral in 2 patients, and located in the anteromedial arterial territory of the upper or middle part of the medulla. Atherosclerosis of the vertebral arteries was the predominant vascular pathology. The vertebral artery was occluded at its terminal portion in 7 patients. Nine patients had hypertension, and 8 of these had additional risk factors. Male gender (10 patients) and smoking habits (7 patients) were more prevalent compared with patients with pontine infarction. One patient had a medial medullary infarction attributed to dissection of the vertebral arteries following blunt head injury. Limb weakness was the major symptom in all patients, and gaze-evoked nystagmus was also frequent (6 patients). Tongue weakness ipsilateral to the infarct, the classic sign of medial medullary syndrome, was evident in only 3 patients. The outcome was usually excellent.

NEUROLOGY 1996;47: 1141-1147




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