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[Conjugate deviation in ischemia of medial medullary oblongata--report of three cases].
Brain Nerve. 2007 Mar; 59(3):277-83.BN

Abstract

Medial medullary infarct (MMI) is a rare type of brain stem infarction. Its clinical picture was characterized by contralateral hemiparesis, deep sensory disturbance, and ipsilateral hypoglossal paresis, but conjugate deviation or nystagmus is uncommon as initial symptom. Case 1: A 73-year-old man developed vomiting and vertigo. Examination revealed right conjugate deviation and horizontal nystagmus beating toward the left side, and numbness on his right upper limb,but no hypoglossal nerve palsy. Cranial MRI demonstrated an infarction in the left paramedian region of the upper medulla and thrombus of the left vertebral artery. Case 2: A 74-year-old man suffered from dizziness and nausea. He showed left conjugate deviation and right-beating horizontal nystagmus without Horner syndrome or hypoglossal nerve palsy. MRI disclosed an infarction in the right upper medial medulla. MRA revealed the right dissecting vertebral artery. Case 3: A 71-year-old man developed vertigo when watching at TV. He showed transient left conjugate deviation and transient motor paresis on the left upper limb. MRI showed the thickened wall of the right vertebral artery but no abnormal ischemic lesion. Digital subtraction angiograms revealed the dissecting right vertebral artery. All ischemic events limited to the upper third of the medulla were caused by the vertebral artery lesions, and prognosis was good. The unilateral MMI lesion in the nucleus prepositus hypoglossi and/or the medullary reticular formation caused contralesional shift of the eyes and ipsilesional nystagmus. The upper MMI will be characterized by a triad of contralateral hemiparesis, deep sensory disturbance and abnormal ocular motor findings.

Authors+Show Affiliations

Department of Neurosurgery, Munakata Suikokai General Hospital, Fukutsu-shi, Fukuoka, Japan.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article
Review

Language

jpn

PubMed ID

17370654

Citation

Kinoshita, Yoshimasa, et al. "[Conjugate Deviation in Ischemia of Medial Medullary Oblongata--report of Three Cases]." Brain and Nerve = Shinkei Kenkyu No Shinpo, vol. 59, no. 3, 2007, pp. 277-83.
Kinoshita Y, Yasukouchi H, Harada A, et al. [Conjugate deviation in ischemia of medial medullary oblongata--report of three cases]. Brain Nerve. 2007;59(3):277-83.
Kinoshita, Y., Yasukouchi, H., Harada, A., Tsuru, E., & Okudera, T. (2007). [Conjugate deviation in ischemia of medial medullary oblongata--report of three cases]. Brain and Nerve = Shinkei Kenkyu No Shinpo, 59(3), 277-83.
Kinoshita Y, et al. [Conjugate Deviation in Ischemia of Medial Medullary Oblongata--report of Three Cases]. Brain Nerve. 2007;59(3):277-83. PubMed PMID: 17370654.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Conjugate deviation in ischemia of medial medullary oblongata--report of three cases]. AU - Kinoshita,Yoshimasa, AU - Yasukouchi,Hideoki, AU - Harada,Atsukuni, AU - Tsuru,Eichi, AU - Okudera,Toshio, PY - 2007/3/21/pubmed PY - 2007/5/2/medline PY - 2007/3/21/entrez SP - 277 EP - 83 JF - Brain and nerve = Shinkei kenkyu no shinpo JO - Brain Nerve VL - 59 IS - 3 N2 - Medial medullary infarct (MMI) is a rare type of brain stem infarction. Its clinical picture was characterized by contralateral hemiparesis, deep sensory disturbance, and ipsilateral hypoglossal paresis, but conjugate deviation or nystagmus is uncommon as initial symptom. Case 1: A 73-year-old man developed vomiting and vertigo. Examination revealed right conjugate deviation and horizontal nystagmus beating toward the left side, and numbness on his right upper limb,but no hypoglossal nerve palsy. Cranial MRI demonstrated an infarction in the left paramedian region of the upper medulla and thrombus of the left vertebral artery. Case 2: A 74-year-old man suffered from dizziness and nausea. He showed left conjugate deviation and right-beating horizontal nystagmus without Horner syndrome or hypoglossal nerve palsy. MRI disclosed an infarction in the right upper medial medulla. MRA revealed the right dissecting vertebral artery. Case 3: A 71-year-old man developed vertigo when watching at TV. He showed transient left conjugate deviation and transient motor paresis on the left upper limb. MRI showed the thickened wall of the right vertebral artery but no abnormal ischemic lesion. Digital subtraction angiograms revealed the dissecting right vertebral artery. All ischemic events limited to the upper third of the medulla were caused by the vertebral artery lesions, and prognosis was good. The unilateral MMI lesion in the nucleus prepositus hypoglossi and/or the medullary reticular formation caused contralesional shift of the eyes and ipsilesional nystagmus. The upper MMI will be characterized by a triad of contralateral hemiparesis, deep sensory disturbance and abnormal ocular motor findings. SN - 1881-6096 UR - https://www.unboundmedicine.com/medline/citation/17370654/[Conjugate_deviation_in_ischemia_of_medial_medullary_oblongata__report_of_three_cases]_ L2 - https://webview.isho.jp/openurl?rft.genre=article&rft.issn=1881-6096&rft.volume=59&rft.issue=3&rft.spage=277 DB - PRIME DP - Unbound Medicine ER -