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[Intermediate medullary infarction: a case report].
No To Shinkei. 2005 Jul; 57(7):607-9.NT

Abstract

A 68-year-old man presented with right eye pain and vertigo. Thereafter, he gradually leaned rightward, then laid down. He felt nausea and vomited. His right upper eyelid drooped and he felt dysethesia of the right hand. On neurological examination, ptosis of his right eye with slightly miotic right pupil, paresis of the right soft palate and hoarseness were noted. Arm deviation test demonstrated rightward deviation. He presented sensory ataxia of the right upper and lower extremities: finger nose test showed mild dysmetria of the right upper extremity, heel knee test demonstrated dysmetria of right lower extremity and these findings worsened when he closed his eyes. He showed mild bending of his bilateral ring and little fingers when he did rapid alternative movement. He leaned rightward when he sat and closed his eyes. Position sense of his right upper and lower extremities was decreased and sometimes he could not answer correctly when asked on which direction his finger pointed. Pinprick sensation was mildly decreased on the left side not including the face. Touch and vibration sense were normal. SEP findings on upper and lower extremity stimulation were normal. MRI of the brain showed T2 high intensity and partially T1 low intensity lesion at the right medulla (Figure). MR angiography showed no apparent lesion of major arteries such as dissection of the vertebral arteries. He complained and presented with hiccup initially. On MRI, the lesion was thought to involve the spinothalamic tract, medial lemniscus and inferior olivary nucleus. Ambiguus nucleus was in the lesion and solitary nucleus near the lesion. There is no report that seems to describe clinical features of a lesion like that in this case. Intermediate medullary infarction may present dissociated sensory disturbance like Brown-Sequard syndrome and position sensory disturbance without disturbance of vibration sense.

Authors+Show Affiliations

Department of Neurology, Chigasaki Tokushukai General Hospital.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

jpn

PubMed ID

16095222

Citation

Kasahata, Naoki, et al. "[Intermediate Medullary Infarction: a Case Report]." No to Shinkei = Brain and Nerve, vol. 57, no. 7, 2005, pp. 607-9.
Kasahata N, Hasegawa O, Tanaka K, et al. [Intermediate medullary infarction: a case report]. No To Shinkei. 2005;57(7):607-9.
Kasahata, N., Hasegawa, O., Tanaka, K., Hanaue, K., Terunuma, N., & Kamei, T. (2005). [Intermediate medullary infarction: a case report]. No to Shinkei = Brain and Nerve, 57(7), 607-9.
Kasahata N, et al. [Intermediate Medullary Infarction: a Case Report]. No To Shinkei. 2005;57(7):607-9. PubMed PMID: 16095222.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Intermediate medullary infarction: a case report]. AU - Kasahata,Naoki, AU - Hasegawa,Osamu, AU - Tanaka,Kyoko, AU - Hanaue,Kazuki, AU - Terunuma,Niina, AU - Kamei,Tetsumasa, PY - 2005/8/13/pubmed PY - 2005/9/3/medline PY - 2005/8/13/entrez SP - 607 EP - 9 JF - No to shinkei = Brain and nerve JO - No To Shinkei VL - 57 IS - 7 N2 - A 68-year-old man presented with right eye pain and vertigo. Thereafter, he gradually leaned rightward, then laid down. He felt nausea and vomited. His right upper eyelid drooped and he felt dysethesia of the right hand. On neurological examination, ptosis of his right eye with slightly miotic right pupil, paresis of the right soft palate and hoarseness were noted. Arm deviation test demonstrated rightward deviation. He presented sensory ataxia of the right upper and lower extremities: finger nose test showed mild dysmetria of the right upper extremity, heel knee test demonstrated dysmetria of right lower extremity and these findings worsened when he closed his eyes. He showed mild bending of his bilateral ring and little fingers when he did rapid alternative movement. He leaned rightward when he sat and closed his eyes. Position sense of his right upper and lower extremities was decreased and sometimes he could not answer correctly when asked on which direction his finger pointed. Pinprick sensation was mildly decreased on the left side not including the face. Touch and vibration sense were normal. SEP findings on upper and lower extremity stimulation were normal. MRI of the brain showed T2 high intensity and partially T1 low intensity lesion at the right medulla (Figure). MR angiography showed no apparent lesion of major arteries such as dissection of the vertebral arteries. He complained and presented with hiccup initially. On MRI, the lesion was thought to involve the spinothalamic tract, medial lemniscus and inferior olivary nucleus. Ambiguus nucleus was in the lesion and solitary nucleus near the lesion. There is no report that seems to describe clinical features of a lesion like that in this case. Intermediate medullary infarction may present dissociated sensory disturbance like Brown-Sequard syndrome and position sensory disturbance without disturbance of vibration sense. SN - 0006-8969 UR - https://www.unboundmedicine.com/medline/citation/16095222/[Intermediate_medullary_infarction:_a_case_report]_ DB - PRIME DP - Unbound Medicine ER -