Since lateral medullary syndrome is often caused by a stroke, diagnosis is time dependent. The most commonly affected artery is the vertebral artery, followed by the PICA, superior middle and inferior medullary arteries. It is the clinical manifestation resulting from occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts, resulting in a typical pattern. Human brainstem blood supply description. Ipsilateral Horner's syndrome (ptosis, miosis, & anhidrosis) Ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis: dysphagia, hoarseness, absent gag reflex (efferent limb-CN X) Nucleus ambiguus - (which affects vagus nerve and glossopharyngeal nerve) - localizing lesion (all other deficits are present in lateral pontine syndrome as well) Ipsilateral deficits in pain and temperature sensation from face Ipsilateral cerebellar signs including ataxia, dysmetria (past pointing), dysdiadochokinesiaĬontralateral deficits in pain and temperature sensation from body (limbs and torso) Vestibular system: Vomiting, vertigo, nystagmus Ĭlinical B1000 diffusion weighted MRI image showing an acute left sided dorsal lateral medullary infarct Based on location Features of lateral medullary syndrome Lateral medullary syndrome can also cause bradycardia, a slow heart rate, and increases or decreases in the patients average blood pressure. Other symptoms include: hoarseness, nausea, vomiting, a decrease in sweating, problems with body temperature sensation, dizziness, difficulty walking, and difficulty maintaining balance. Palatal myoclonus, the twitching of the muscles of the mouth, may be observed due to disruption of the central tegmental tract. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms that are similar to the symptoms caused by Horner's syndrome – such as miosis, anhidrosis and partial ptosis. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Slurred speech ( dysarthria), and disordered vocal quality ( dysphonia) are also common. This can be caused by the involvement of the nucleus ambiguus, as it supplies the vagus and glossopharyngeal nerves. Ĭommon symptoms with lateral medullary syndrome may include difficulty swallowing, or dysphagia. These vertigo spells can result in falling, caused from the involvement of the region of Deiters' nucleus. The nystagmus is commonly associated with vertigo spells. Some patients may walk with a slant or experience skew deviation and illusions of room tilt. Patients often have difficulty walking or maintaining balance ( ataxia), or difference in temperature of an object based on which side of the body the object of varying temperature is touching. The cross body finding is the chief symptom from which a diagnosis can be made. Specifically a loss of pain and temperature sensation if the lateral spinothalamic tract is involved. This syndrome is characterized by sensory deficits that affect the trunk and extremities contralaterally (opposite to the lesion), and sensory deficits of the face and cranial nerves ipsilaterally (same side as the lesion).
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