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Dorsal Medullary Infarction: Distinct Syndrome of Isolated Central Vestibulopathy
Sun-Uk Lee1, Seong-Ho Park1, Jeong-Jin Park1
1From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
Background And Purpose:
The characteristics of infarctions restricted to the dorsal medulla have received little attention. This study aimed to define the distinct clinical features of dorsal medullary infarction.
Methods:
Of the 172 patients with a diagnosis of medullary infarction at Seoul National University Bundang Hospital from 2003 to 2014, 18 patients with isolated dorsal medullary infarction were subjected to analyses of clinical and laboratory findings.
Results:
All patients presented acute isolated vestibular syndrome with dizziness/vertigo and imbalance. Almost all patients (17/18, 94%) showed the signs from involvements of the vestibular nuclei, nucleus prepositus hypoglossi, or inferior cerebellar peduncle, which included direction-changing gaze-evoked nystagmus (n=12), negative head-impulse tests (n=8), skew deviation (n=7), central patterns of head-shaking nystagmus (n=6), and spontaneous nystagmus (n=2). Initial magnetic resonance imagings including diffusion-weighted images were negative in 7 patients (39%). Twelve patients (67%) showed a progression and developed additional neurological abnormalities, but the neurological outcomes were favorable.
Conclusions:
The presence of central vestibular signs allows bedside differentiation of isolated vestibular syndrome because of dorsal medullary infarction from acute peripheral vestibular disorders. Because initially false-negative magnetic resonance imagings and subsequent progression are frequent in dorsal medullary infarction, early recognition through scrutinized evaluation is important for proper managements.
Insights
Dorsal medullary infarction causes acute vestibular syndrome. Central vestibular signs help differentiate it from peripheral disorders, but early recognition is key due to potential MRI inaccuracies.
Area of Science:
- Neurology
- Neuroscience
- Vascular Neurology
Background:
- Dorsal medullary infarction is a rare stroke subtype.
- Its distinct clinical features remain under-explored.
Purpose of the Study:
- To define the unique clinical characteristics of isolated dorsal medullary infarction.
- To aid in differentiating these strokes from peripheral vestibular conditions.
Main Methods:
- Retrospective analysis of 18 patients with isolated dorsal medullary infarction.
- Evaluation of clinical, laboratory, and neuroimaging findings.
Main Results:
- All patients presented with acute isolated vestibular syndrome (dizziness, vertigo, imbalance).
- Central vestibular signs were prevalent (e.g., gaze-evoked nystagmus, skew deviation).
- Initial MRI was negative in 39%, and 67% showed progression, though outcomes were favorable.
Conclusions:
- Central vestibular signs are crucial for bedside differentiation of dorsal medullary infarction from peripheral causes.
- Early, careful evaluation is vital due to frequent initial false-negative MRIs and subsequent progression.
