Medial medullary syndrome with contralateral face hypalgesia: a report of two cases

Classically, patients with unilateral medial medullary syndromes show contralateral deep sensory loss, contralateral hemiparesis, and ipsilateral tongue paralysis. We encountered two patients with medial medullary syndromes showing hypalgesia of the contralateral face. Both patients had contralateral deep sensory loss and hemiparesis, but no hypoglossal nerve palsy, so it was difficult to establish a medial medullary syndrome from the clinical neurological signs alone. Magnetic resonance images showed that the infarcted areas were located in the ventromedial area of the upper medulla, probably involving the trigeminothalamic tract in the medial lemniscus. We reviewed the reported cases of medial medullary syndromes and summarized their clinical features as well as the topography concerned with the associated sensory disturbances.