Journal of Neurology

, Volume 242, Issue 4, pp 195–202 | Cite as

The medullary vascular syndromes revisited

  • R. Gan
  • A. Noronha
Original Communication


There are two major vascular syndromes of the medulla oblongata: the medial and the lateral. The medial medullary syndrome is characterized by the triad of ipsilateral hypoglossal nerve palsy with contralateral hemiparesis and loss of deep sensation. Lateral medullary infarction commonly presents with Homer's syndrome, ataxia, alternating thermoanalgesia, nystagmus, vertigo and hoarseness. Combinations of the two major syndromes occur as bilateral medial medullary, hemi-medullary and bilateral lateral medullary syndromes. Each of these syndromes frequently manifests with incomplete or atypical findings depending on the extent of the lesion. Magnetic resonance imaging has been useful in the clinical diagnosis of medullary infarctions. The site of the lesion may help predict the arteries involved.

Key words

Medullary syndrome Magnetic resonance imaging Brainstem infarction 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Babinski J, Nageotte J (1902) Hemiasynergie, lateropulsion et myosis bulbaires avec hemianesthesie et hemiplegie croisees. Rev Neurol (Paris) 10:358–365Google Scholar
  2. 2.
    Balch RW, Spooner JW (1981) Downbeat nystagmus: a type of central vestibular nystagmus. Neurology 31:304–310Google Scholar
  3. 3.
    Bogousslavsky J, Khurana R, Deruaz JP, et al. (1990) Respiratory failure and unilateral caudal brainstem infarction. Ann Neurol 28:668–673Google Scholar
  4. 4.
    Bogousslavsky J, Regli F, Maeder P, et al (1993) The etiology of posterior circulation infarcts: a prospective study using magnetic resonance imaging and magnetic resonance angiography. Neurology 43:1528–1533Google Scholar
  5. 5.
    Bucy PC, Keplinger JE, Siqueira EB (1964) Destruction of the “pyramidal tract” in man. J Neurosurg 21:385–398Google Scholar
  6. 6.
    Caplan LR (1983) Bilateral distal vertebral artery occlusion. Neurology 33:552–558Google Scholar
  7. 7.
    Caplan LR (1988) Vertebrobasilar system syndromes. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 53. Elsevier, New York, pp 371–408Google Scholar
  8. 8.
    Caplan LR, Zarins CK, Hemmati M (1985) Spontaneous dissection of the extracranial vertebral arteries. Stroke 16:1030–1038Google Scholar
  9. 9.
    Chokroverty S, Rubino FA, Haller C (1975) Pure motor hemiplegia due to pyramidal infarction. Arch Neurol 32:647–648Google Scholar
  10. 10.
    Currier RD (1969) Syndromes of the medulla oblongata. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol 2. North-Holland, New York, pp 217–237Google Scholar
  11. 11.
    Currier RD (1976) The medial medullary syndrome. J Univ Mich Med Center 42:96–104Google Scholar
  12. 12.
    Davison C (1944) Syndrome of the anterior spinal artery of the medulla oblongata. J Neuropathol Exp Neurol 3:73–80Google Scholar
  13. 13.
    Dejerine J (1914) Semiologie des affections du systeme nerveux. Masson, Paris, pp 226–230Google Scholar
  14. 14.
    Devereaux MW, Keane JR, Davis RL (1973) Automatic respiratory failure associated with infarction of the medulla. Arch Neurol 29:46–52Google Scholar
  15. 15.
    Fisher CM, Karnes WE, Kubik CS (1961) Lateral medullary infarction — the pattern of vascular occlusion. J Neuropathol Exp Neurol 20:323–379Google Scholar
  16. 16.
    Fox AJ, Bogousslavsky J, Carey LS, et al (1986) Magnetic resonance imaging of small medullary infarcts. AJNR 7:229–233Google Scholar
  17. 17.
    Gillilan LA (1964) The correlation of the blood supply to the human brain stem with clinical brain stem lesions. J Neuropathol Exp Neurol 23:78–108Google Scholar
  18. 18.
    Ho KL, Meyer KR (1981) The medial medullary syndrome. Arch Neurol 38:385–387Google Scholar
  19. 19.
    Jagiella WM, Sung JH (1989) Bilateral infarction of the medullary pyramids in humans. Neurology 39:21–24Google Scholar
  20. 20.
    Kase CS, Varakis JN, Stafford JR, Mohr JP (1983) Medial medullary infarction from fibrocartilaginous embolism to the anterior spinal artery. Stroke 14:413–418Google Scholar
  21. 21.
    Kleinert G, Fazekas F, Kleinert R, et al (1993) Bilateral medial medullary infarction: magnetic resonance imaging and correlative histopathologic findings. Eur Neurol 33:74–76Google Scholar
  22. 22.
    Krayenbuhl H, Yasargil G (1957) Der subtentorielle Kollateralkreislauf im angiographischen Bild. Ein pathogenetischer Beitrag zur Klinik der vascularen bulbopontinen Syndrome. Dtsch Z Nervenheilkd 177:103–116Google Scholar
  23. 23.
    Lazorthes G, Poulhes J, Bastide G, et al (1958) Les territoires arteriels du tronc cerebral. Recherches anatomiques et syndromes vasculaires. Presse Med 66:2048–2051Google Scholar
  24. 24.
    Leestma JE, Noronha A (1976) Pure motor hemiplegia, medullary pyramid lesion, and olivary hypertrophy. J Neurol Neurosurg Psychiatry 39:877–884Google Scholar
  25. 25.
    Levin BE, Margolis G (1977) Acute failure of automatic respiration secondary to a unilateral brainstem infarct. Ann Neurol 1:583–586Google Scholar
  26. 26.
    Mizutani T, Lewis RA, Gonatas NK (1980) Medial medullary syndrome in a drug abuser. Arch Neurol 37:425–428Google Scholar
  27. 27.
    Mossuto-Agatiello L, Kniahynicki C (1990) The hemimedullary syndrome: case report and review of the literature. J Neurol 237:208–212Google Scholar
  28. 28.
    Nishiyama K, Fuse S, Shimizu J, et al (1992) A case of fibromuscular dysplasia presenting with Wallenberg syndrome and developing a giant aneurysm of the internal carotid artery in the cavernous sinus. Rinsho Shinkeigaku 32:1117–1120Google Scholar
  29. 29.
    Reinhold H (1894) Beiträge zur Pathologie der acuten Erweichungen des Pons und der Oblongata. Zugleich ein Beitrag zur Lehre von der “Bulbaren Ataxie”. Dtsch Z Nervenheilkd 5:351–374Google Scholar
  30. 30.
    Romano J, Merritt HH (1941) The singular affection of Gaspard Vieusseux: an early description of the lateral medullary syndrome. Bull Hist Med 9:72–79Google Scholar
  31. 31.
    Ropper AH, Fischer CM, Kleinman GM (1979) Pyramidal infarction in the medulla: a cause of pure motor hemiplegia sparing the face. Neurology 29:91–95Google Scholar
  32. 32.
    Ross MA, Biller J, Adams HP Jr, Dunn V (1986) Magnetic resonance imaging in Wallenberg's lateral medullary syndrome. Stroke 17:542–545Google Scholar
  33. 33.
    Sacco RL, Freddo L, Bello JA, et al (1993) Wallenberg's lateral medullary syndrome: clinical-magnetic resonance imaging correlations. Arch Neurol 50:609–614Google Scholar
  34. 34.
    Sawada H, Seriu N, Udaka F, et al (1990) Magnetic resonance imaging of medial medullary infarction. Stroke 21:963–966Google Scholar
  35. 35.
    Spiller WG (1908) The symptom-complex of a lesion of the uppermost portion of the anterior spinal and adjoining portion of the vertebral arteries. J Nerv Ment Dis 35:775–778Google Scholar
  36. 36.
    Stopford JSB (1916) The arteries of the pons and medulla oblongata. J Anat Physiol 50:131–164 and 255–280Google Scholar
  37. 37.
    Toyoda K, Hasegawa Y, Yonehara T, et al (1992) Bilateral medial medullary infarction with oculomotor disorders. Stroke 23:1657–1659Google Scholar
  38. 38.
    Trelles JO, Trelles L, Urquiaga C (1973) Le remollissement median du bulbe. A propos de deux cas anatomocliniques. Rev Neurol (Paris) 129:91–104Google Scholar
  39. 39.
    Wallenberg A (1895) Acute Bulbaraffection (Embolie der Art. cerebellar post. inf. sinistr.). Arch Psychiatr Nervenkr 27:504–540Google Scholar
  40. 40.
    Wallenberg A (1901) Anatomischer Befund in einem als “Acute Bulbaraffection” (Embolie der Art. cerebellar post. inf. sinistr.) beschriebenen Falle. Arch Psychiatr Nervenkr 34:923–959Google Scholar

Copyright information

© Springer-Verlag 1995

Authors and Affiliations

  • R. Gan
    • 1
  • A. Noronha
    • 1
  1. 1.Department of NeurologyThe University of ChicagoChicagoUSA

Personalised recommendations