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Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Medial medullary infarction: clinical, imaging, and outcome study in 86 consecutive patients
1Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea. jongskim@amc.seoul.kr
Background And Purpose:
Clinical-imaging correlation and long-term clinical outcomes remain to be investigated in medial medullary infarction (MMI).
Methods:
We studied clinical, MRI, and angiographic data of 86 consecutive MMI patients. The lesions were correlated with clinical findings, and long-term outcomes, divided into mild and severe (modified Rankin scale >3), were assessed by telephone interview. Central poststroke pain (CPSP) was defined as persistent pain with visual numeric scale > or = 4.
Results:
The lesions were located mostly in the rostral medulla (rostral 76%, rostral+middle 16%), while ventro-dorsal lesion patterns include ventral (V, 20%), ventral+middle (VM, 33%), and ventral+middle+dorsal (VMD, 41%). Clinical manifestations included motor dysfunction in 78 patients (91%), sensory dysfunction in 59 (73%), and vertigo/dizziness in 51 (59%), each closely related to involvement of ventral, middle, and dorsal portions, respectively (P<0.001, each). Vertebral artery (VA) atherosclerotic disease relevant to the infarction occurred in 53 (62%) patients, mostly producing atheromatous branch occlusion (ABO). Small vessel disease (SVD) occurred in 24 (28%) patients. ABO was more closely related to VMD (versus V+VM) than was SVD (P=0.035). During follow-up (mean 71 months), 11 patients died, and recurrent strokes occurred in 11. Old age (P=0.001) and severe motor dysfunction at admission (P=0.001) were factors predicting poor prognosis. CPSP, occurring in 21 patients, was closely (P=0.013) related to poor clinical outcome.
Conclusion:
MMI usually presents with a rostral medullary lesion, with a good clinical ventro-dorsal imaging correlation, caused most frequently by ABO followed by SVD. A significant proportion of patients remain dependent or have CPSP.
Insights
Medial medullary infarction (MMI) typically involves rostral lesions and shows good imaging-clinical correlation. Atheromatous branch occlusion is a common cause, and central poststroke pain is linked to poor outcomes.
Area of Science:
- Neurology
- Neuroimaging
- Stroke Medicine
Background:
- Medial medullary infarction (MMI) clinical-imaging correlation and long-term outcomes require further investigation.
- Understanding these aspects is crucial for managing MMI patients effectively.
Purpose of the Study:
- To correlate clinical findings with imaging in MMI.
- To assess long-term clinical outcomes, including functional status and central poststroke pain (CPSP).
Main Methods:
- Retrospective analysis of clinical, MRI, and angiographic data from 86 MMI patients.
- Correlation of lesion location with clinical manifestations.
- Assessment of long-term outcomes (modified Rankin Scale) and CPSP via telephone interviews.
Main Results:
- Lesions predominantly affected the rostral medulla, with significant correlations between ventro-dorsal lesion patterns and motor, sensory, and vestibular symptoms.
- Vertebral artery atherosclerotic disease causing atheromatous branch occlusion (ABO) was more frequent than small vessel disease (SVD) and associated with more extensive lesions.
- Old age, severe initial motor dysfunction, and CPSP were predictors of poor long-term prognosis, with 11 deaths and 11 recurrent strokes during a mean 71-month follow-up.
Conclusions:
- MMI commonly presents with rostral medullary lesions and demonstrates good ventro-dorsal imaging-clinical correlation.
- ABO is the most frequent cause, followed by SVD.
- A substantial number of MMI patients experience long-term dependency or develop CPSP.
