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Published on: September 19, 2019
Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients
1Department of Neurology, Asan Medical Center, Song-Pa PO Box 145, Seoul 138-600, South Korea. jongskim@amc.seoul.kr
Abstract:
Although there have been attempts to make clinical-MRI correlation in patients with lateral medullary infarction (LMI), studies with a large number of patients are unavailable. In this study, clinical features, MRI findings and angiogram results of 130 acute, consecutive patients with pure LMI were studied and correlated. MRI-identified lesions were classified rostro-caudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. The distribution of horizontal subtypes was significantly different (P <0.001) among three rostro-caudal lesions in that rostral lesions tend to be ventral types and caudal lesions are lateral types. Patients with rostrally located lesions had dysphagia, facial paresis (P < 0.01, each) and dysarthria (P < 0.05) significantly more often, and severe gait ataxia and headache (P < 0.05, each) less often than those with caudal lesions. The frequencies of dysphagia (P < 0.01), dysarthria (P < 0.01) and bilateral trigeminal sensory pattern (P < 0.05) were significantly different among horizontal subtypes in that these symptoms were frequent in patients with "large type" as compared with those with lateral type lesions. Angiograms performed in 123 patients showed vertebral artery (VA) disease in 67% and posterior inferior cerebellar artery (PICA) disease in 10%. The presumed pathogenetic mechanisms included large vessel infarction in 50%, arterial dissection in 15%, small vessel infarction in 13% and cardiac embolism in 5%. Dissection occurred more often in patients with caudal (versus rostral) lesions (P < 0.01), whereas dorsal type infarcts (versus other types) were related more often to cardiogenic embolism and normal angiogram findings (P < 0.05, each). Patients with isolated PICA disease (versus those with VA disease) more often had cardiogenic embolism (P < 0.05) and less often had dissection (P < 0.01). It is concluded that rostro-caudal and horizontal classification of MRI helps us to understand the clinical and, partly, the aetiopathogenetic aspect of the heterogeneous LMI syndrome.
Insights
This study of 130 lateral medullary infarction patients found MRI lesion classification correlates with clinical symptoms and causes. Rostro-caudal and horizontal MRI subtypes help understand LMI heterogeneity.
Area of Science:
- Neurology
- Radiology
- Neuroscience
Background:
- Lateral medullary infarction (LMI) is a stroke subtype with varied clinical presentations.
- Previous studies correlating clinical features with MRI in LMI are limited by small sample sizes.
Purpose of the Study:
- To investigate the correlation between clinical symptoms, MRI findings, and etiological mechanisms in a large cohort of acute LMI patients.
- To classify LMI lesions based on rostro-caudal and horizontal MRI characteristics and analyze their clinical and etiological associations.
Main Methods:
- Retrospective analysis of 130 consecutive acute LMI patients.
- Classification of MRI lesions into rostro-caudal (rostral, middle, caudal) and horizontal (typical, ventral, large, lateral, dorsal) subtypes.
- Correlation of MRI subtypes with clinical symptoms (dysphagia, facial paresis, dysarthria, ataxia, headache) and angiogram results (vertebral artery, PICA disease).
Main Results:
- Significant differences in horizontal lesion distribution across rostro-caudal subtypes (P <0.001), with rostral lesions often ventral and caudal lesions lateral.
- Specific clinical symptoms like dysphagia and facial paresis were more frequent with rostral lesions, while ataxia and headache were less common compared to caudal lesions.
- The "large type" horizontal subtype was associated with higher frequencies of dysphagia, dysarthria, and bilateral trigeminal sensory patterns compared to the lateral type.
Conclusions:
- Rostro-caudal and horizontal classification of MRI lesions in LMI provides valuable insights into clinical presentation.
- These MRI classifications offer partial understanding of the heterogeneous etiological mechanisms underlying LMI.
- The findings highlight the importance of detailed MRI analysis for predicting clinical outcomes and identifying stroke causes in LMI.
