top of page
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute
Asian Institute of Research, Journal Publication, Journal Academics, Education Journal, Asian Institute

Journal of Health and Medical Sciences

ISSN 2622-7258

Screen Shot 2018-08-12 at 1.24.09 AM.png
Screen Shot 2018-08-12 at 1.24.02 AM.png
Screen Shot 2018-08-12 at 1.23.57 AM.png
Screen Shot 2018-08-12 at 1.23.52 AM.png
crossref
doi
open access

Published: 25 April 2023

Bilateral Medial Medullary Stroke: A Single Center Case Series

Vanessa Rose Magan, Peter Allan Quitasol

Baguio General Hospital and Medical Center, Philippines

journal of social and political sciences
pdf download

Download Full-Text Pdf

doi

10.31014/aior.1994.06.02.262

Pages: 1-7

Keywords: Stroke Syndromes, Bilateral Medial Medullary Infarct, Rare, Good Outcome

Abstract

Introduction. Stroke in the posterior circulation accounts for 20-30% of ischemic strokes (Frid et al., 2019). The medial medullary stroke accounts for less than 1%. It is caused by a lesion in the vertebral artery or its branches, or the anterior spinal artery (Ropper, Samuels, Klein J, & Prasad, 2019). Prognosis depends on the age of the patient and the severity of the motor deficit on admission (Kim & Han, 2019). A bilateral medial medullary infarct is thus very rare. Methodology. We therefore present a case series of three patients in a tertiary hospital in the Philippines and describe their clinicodemographic profile, clinical presentation, imaging and ancillary diagnostic characteristics and outcome. Age range was from 35 to 64 years old. All three presented with dizziness and varying combinations of cranial nerve deficits, motor, sensory ataxia and cerebellar signs. Imaging modalities used are Magnetic Resonance Imaging (MRI) with time of flight (TOF) and computed tomography angiography (CTA). One had a left vertebral artery (VA) occlusion extending into the proximal basilar artery (BA). Another had a non-visualized right VA and bilateral posterior inferior cerebellar artery (PICA). The last case had an unremarkable vessel study. Treatment strategies include dual antiplatelet therapy (DAPT) with Aspirin and Cilostazol (2 of 3), and Enoxaparin plus Aspirin. One received intravenous thrombolysis with Alteplase prior to the DAPT. None were intubated and all were home discharged. Conclusion. We have shown that a bilateral medial medullary stroke can present with minimal disability and a good outcome.

References

  1. Caplan, L. R., & Van Gijn, J. (2012). Stroke Syndromes, 3ed. Cambridge University Press.

  2. Deshpande, A., Chandran, V., Pai, A., Rao, S., & Shetty, R. (2013). Bilateral medial medullary syndrome secondary to Takayasu arteritis. Case Reports, 2013(aug13 1). https://doi.org/10.1136/bcr-01-2012-5600

  3. Frid, P., Drake, M., Pichler, B. J., Wassélius, J., Schirmer, M. D., Donahue, K. L., Cloonan, L., Irie, R. E., Bouts, M. J. R. J., McIntosh, E., Mocking, S. J. T., Dalca, A. V., Sridharan, R., Xu, H. E., Giralt-Steinhauer, E., Holmegaard, L., Jood, K., Roquer, J., Cole, J. W., . . . Lindgren, A. (2020). Detailed phenotyping of posterior vs. anterior circulation ischemic stroke: a multi-center MRI study. Journal of Neurology, 267(3), 649–658. https://doi.org/10.1007/s00415-019-09613-5

  4. Hu, F., Nie, H., Bai, Y., Liang, X., Li, L., & Shen, Y. (2022). The stroke mechanism, clinical presentation, and radiological feature of bilateral medial medullary infarction. Neurological Sciences, 43(12), 6881–6888. https://doi.org/10.1007/s10072-022-06382-4

  5. Kim, J. M., & Han, Y. M. (2009). Medial Medullary Infarction. Stroke, 40(10), 3221 3225. https://doi.org/10.1161/strokeaha.109.559864

  6. Pongmoragot, J., Parthasarathy, S., Selchen, D., & Saposnik, G. (2013). Bilateral Medial Medullary Infarction: A Systematic Review. Journal of Stroke and Cerebrovascular Diseases, 22(6), 775–780. https://doi.org/10.1016/j.jstrokecerebrovasdis.2012.03.010

  7. Ropper, A. H., Samuels, M. A., Klein, J., & Prasad, S. (2019b). Adams and Victor’s Principles of Neurology 11th Edition. McGraw-Hill Education / Medical.

  8. Tao, W., Li, M., Fisher, M., Wang, D., Li, J., Furie, K. L., Hao, Z., Lin, S., Zhang, C., Zeng, Q., & Wu, B. (2012). Posterior Versus Anterior Circulation Infarction. Stroke, 43(8), 2060–2065. https://doi.org/10.1161/strokeaha.112.652420

  9. Torabi, A. (2013). Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis. Case Reports in Neurological Medicine, 2013, 1–3. https://doi.org/10.1155/2013/274373

  10. Zheng, R., Zhang, T., Zeng, X., Yu, M., Jin, Z., & Zhang, J. (2022). Unusual neurological manifestations of bilateral medial medullary infarction: A case report. Open Medicine, 17(1), 119–123. https://doi.org/10.1515/med-2021-0382

  11. Zürcher, E., Richoz, B., Faouzi, M., & Michel, P. (2019). Differences in Ischemic Anterior and Posterior Circulation Strokes: A Clinico-Radiological and Outcome Analysis. Journal of Stroke and Cerebrovascular Diseases, 28(3), 710–718. https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.016

bottom of page