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Lateral medullary infarction with ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy.

Abstract
Here, we present a rare case of a lateral medullary infarction with ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy. In this case, we proved Opalski's hypothesis by diffusion tensor tractography that ipsilateral hemiparesis in a medullary infarction is due to the involvement of the decussated corticospinal tract. We found that the clinical triad of ipsilateral hemiparesis, lemniscal sensation loss and hypoglossal nerve palsy, which had been regarded as a variant of medial medullary syndrome, turned out to be caused by lateral lower medullary infarction. Therefore, this clinical triad does not imply the involvement of the anteromedial part of medulla oblongata, when it is hard to distinguish a massive lateral medullary infarction from a hemimedullary infarction merely from MR images. At last, we suggest that hyperreflexia and Babinski's sign may not be indispensable to the diagnosis of Opalski's syndrome and we propose that "hemimedullary infarction with ipsilateral hemiparesis" is intrinsically a variant of lateral medullary infarction.
AuthorsXiaodi Li, Yuzhou Wang
JournalNeurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology (Neurol Sci) Vol. 35 Issue 4 Pg. 633-4 (Apr 2014) ISSN: 1590-3478 [Electronic] Italy
PMID24469346 (Publication Type: Case Reports, Letter)
Topics
  • Adult
  • Brain Stem Infarctions (complications, diagnosis)
  • Female
  • Humans
  • Hypesthesia (diagnosis, etiology)
  • Hypoglossal Nerve Diseases (diagnosis, etiology)
  • Medulla Oblongata (blood supply)
  • Paresis (diagnosis, etiology)

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