Bilateral medial medullary infarction: a systematic review

Area of Science:

• Neurology
• Vascular Neurology
• Neuroimaging

Background:

• Bilateral infarction of the medial medulla (MMI) is a rare condition with limited data on its clinical features, causes, and prognosis.
• High-resolution neuroimaging is crucial for identifying stroke mechanisms.

Purpose of the Study:

• To systematically review and analyze clinical presentations, stroke mechanisms, and outcomes in patients with bilateral MMI.

Main Methods:

• Systematic literature review of studies published between 1992 and 2011.
• Searched Medline, EMBASE, and Web of Science for magnetic resonance imaging-proven bilateral MMI cases.
• Included 29 articles detailing 38 patient cases.

Main Results:

• The 38 patients (mean age 62.2 years, 74.2% male) commonly presented with motor weakness (78.4%), dysarthria (48.6%), and hypoglossal palsy (40.5%).
• Vertebral artery atherosclerosis was the most frequent vascular pathology (38.5%).
• Poor clinical outcomes were observed, with inpatient mortality at 23.8% and 12-month case fatality at 61.9%.

Conclusions:

• Bilateral medial medullary infarction is a rare stroke syndrome.
• Clinical presentations often involve rostral medullary lesions.
• Large-artery atherosclerosis and branch disease are common stroke mechanisms, and outcomes are typically poor.