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Portable Thermographic Screening for Detection of Acute Wallenberg's Syndrome
Published on: September 19, 2019
Clinical review of 37 patients with medullary infarction
Takuya Fukuoka1, Hidetaka Takeda, Tomohisa Dembo
1Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center, Saitama, Japan. tfukuoka@saitama-med.ac.jp
Background:
Clinical features of medullary infarction were compared between patients with lateral medullary infarction and medial medullary infarction
Methods:
Thirty-seven patients with medullary infarction (29 with lateral medullary infarction and 8 with medial medullary infarction) who were admitted to our center between April 1, 2007 and March 31, 2010 were examined. Background factors, neurologic signs and symptoms, imaging findings, cause of disease, and outcomes were assessed for patients with lateral and those with medial medullary infarction.
Results:
Examination of the clinical symptoms and neurologic findings suggested that among patients with medial medullary infarction, few demonstrated all of the symptoms of Dejerine syndrome at onset, and many had lesions that were difficult to locate based only on neurologic findings. Both lateral and medial medullary infarction were frequently caused by atherothrombosis. However, cerebral artery dissection was observed in 31% of patients with lateral medullary infarction and 12.5% of those with medial medullary infarction. In 13% of patients with lateral and 37% of patients with medial medullary infarction, magnetic resonance imaging diffusion-weighted images on the day of onset did not show abnormalities, and the second set of diffusion-weighted images confirmed infarction lesions. For lateral medullary infarction, a more rostral lesion location was correlated with a poorer 90-day outcome. For medial medullary infarction, a more dorsal lesion location was correlated with a poorer 90-day outcome.
Conclusions:
The diagnosis rate of medullary infarction using imaging examinations at onset--particularly medial medullary infarction--is not necessarily high. The imaging examinations need to be repeated for patients who are suspected to have medullary infarction based on neurologic signs and symptoms.
Insights
Medullary infarction diagnosis can be challenging, especially for medial cases, often requiring repeat imaging. Lesion location impacts outcomes in both lateral and medial medullary infarction.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Medullary infarction presents as either lateral or medial subtypes.
- Clinical features distinguishing these subtypes are not fully understood.
Purpose of the Study:
- To compare clinical features between lateral medullary infarction and medial medullary infarction.
- To identify diagnostic challenges and prognostic factors.
Main Methods:
- Retrospective analysis of 37 medullary infarction patients (29 lateral, 8 medial).
- Assessment of background factors, neurologic signs/symptoms, imaging, etiology, and outcomes.
- Comparison between lateral and medial medullary infarction groups.
Main Results:
- Medial medullary infarction patients often lacked complete Dejerine syndrome signs and had difficult-to-localize lesions.
- Atherothrombosis was a common cause for both subtypes.
- Cerebral artery dissection was more frequent in lateral medullary infarction.
- Initial MRI diffusion-weighted images were negative in 13% of lateral and 37% of medial cases.
- Rostral lesion location correlated with poorer outcomes in lateral infarction; dorsal location in medial infarction.
Conclusions:
- Diagnosis of medullary infarction, particularly medial, can be missed on initial imaging.
- Repeat imaging is crucial for suspected medullary infarction cases based on clinical presentation.
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