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[A case of medial medullary infarction with prominent deep sensory impairment].
No To Shinkei. 1996 Oct; 48(10):937-41.NT

Abstract

We report a patient with medial medullary infarction who showed deep sensory impairment as his prominent neurological manifestation. A 54-year-old man with a history of hypertension was admitted to our hospital with numbness of the bilateral upper and lower extremities, followed by dysarthria and right hemiparesis. Physical examination revealed no abnormalities except for high blood pressure. He hiccuped continuously. On neurological examination, he exhibited dysarthria, mild dysphagia and right hemiparesis without facial or lingual paresis. Sensitivity to light touch and pinprick was normal, but sensitivity to vibration and joint position was severely decreased in the bilateral upper and lower extremities, predominantly in the lower extremities and on the right side in the upper extremities. He had been treated with antiedema agents and thromboxane synthetase inhibitor. His hiccups stopped within two weeks, and his right hemiparesis gradually improved within one month. However, his deep sensory impairments remained prominent. Blood examinations disclosed positive lupus anticoagulant. MRI showed bilateral infarction at the medial portion of the upper medulla oblongata, extending to both pyramids, especially on the left. Somatosensory evoked potentials (SEP) after median nerve stimulation showed P14 and the later components with prolonged latency. No SEP were recorded after posterior tibial nerve stimulation. The latency of P14 was well correlated with the severity of deep sensory impairments in the upper extremities. Neurological manifestations of our patient are not typical of medial medullary infarction, and are informative about the functional anatomy of the deep sensory tract in the medulla oblongata. We discuss the relation of the intractable hiccups to the bilateral medial medullary lesions, and emphasize the importance of lupus anticoagulant as one of the risk factors in brainstem infarction.

Authors+Show Affiliations

Department of Neurology, Tokai University School of Medicine, Isehara, Japan.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
English Abstract
Journal Article

Language

jpn

PubMed ID

8921533

Citation

Yoshii, F, et al. "[A Case of Medial Medullary Infarction With Prominent Deep Sensory Impairment]." No to Shinkei = Brain and Nerve, vol. 48, no. 10, 1996, pp. 937-41.
Yoshii F, Shinohara Y, Tamura K, et al. [A case of medial medullary infarction with prominent deep sensory impairment]. No To Shinkei. 1996;48(10):937-41.
Yoshii, F., Shinohara, Y., Tamura, K., & Iyori, S. (1996). [A case of medial medullary infarction with prominent deep sensory impairment]. No to Shinkei = Brain and Nerve, 48(10), 937-41.
Yoshii F, et al. [A Case of Medial Medullary Infarction With Prominent Deep Sensory Impairment]. No To Shinkei. 1996;48(10):937-41. PubMed PMID: 8921533.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [A case of medial medullary infarction with prominent deep sensory impairment]. AU - Yoshii,F, AU - Shinohara,Y, AU - Tamura,K, AU - Iyori,S, PY - 1996/10/1/pubmed PY - 1996/10/1/medline PY - 1996/10/1/entrez SP - 937 EP - 41 JF - No to shinkei = Brain and nerve JO - No To Shinkei VL - 48 IS - 10 N2 - We report a patient with medial medullary infarction who showed deep sensory impairment as his prominent neurological manifestation. A 54-year-old man with a history of hypertension was admitted to our hospital with numbness of the bilateral upper and lower extremities, followed by dysarthria and right hemiparesis. Physical examination revealed no abnormalities except for high blood pressure. He hiccuped continuously. On neurological examination, he exhibited dysarthria, mild dysphagia and right hemiparesis without facial or lingual paresis. Sensitivity to light touch and pinprick was normal, but sensitivity to vibration and joint position was severely decreased in the bilateral upper and lower extremities, predominantly in the lower extremities and on the right side in the upper extremities. He had been treated with antiedema agents and thromboxane synthetase inhibitor. His hiccups stopped within two weeks, and his right hemiparesis gradually improved within one month. However, his deep sensory impairments remained prominent. Blood examinations disclosed positive lupus anticoagulant. MRI showed bilateral infarction at the medial portion of the upper medulla oblongata, extending to both pyramids, especially on the left. Somatosensory evoked potentials (SEP) after median nerve stimulation showed P14 and the later components with prolonged latency. No SEP were recorded after posterior tibial nerve stimulation. The latency of P14 was well correlated with the severity of deep sensory impairments in the upper extremities. Neurological manifestations of our patient are not typical of medial medullary infarction, and are informative about the functional anatomy of the deep sensory tract in the medulla oblongata. We discuss the relation of the intractable hiccups to the bilateral medial medullary lesions, and emphasize the importance of lupus anticoagulant as one of the risk factors in brainstem infarction. SN - 0006-8969 UR - https://www.unboundmedicine.com/medline/citation/8921533/[A_case_of_medial_medullary_infarction_with_prominent_deep_sensory_impairment]_ L2 - https://antibodies.cancer.gov/detail/CPTC-CTNNBL1-1 DB - PRIME DP - Unbound Medicine ER -