Document Detail

Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients.
MedLine Citation:
PMID:  12805095     Owner:  NLM     Status:  MEDLINE    
Although there have been attempts to make clinical-MRI correlation in patients with lateral medullary infarction (LMI), studies with a large number of patients are unavailable. In this study, clinical features, MRI findings and angiogram results of 130 acute, consecutive patients with pure LMI were studied and correlated. MRI-identified lesions were classified rostro-caudally as rostral, middle and caudal, and horizontally as typical, ventral, large, lateral and dorsal. The distribution of horizontal subtypes was significantly different (P <0.001) among three rostro-caudal lesions in that rostral lesions tend to be ventral types and caudal lesions are lateral types. Patients with rostrally located lesions had dysphagia, facial paresis (P < 0.01, each) and dysarthria (P < 0.05) significantly more often, and severe gait ataxia and headache (P < 0.05, each) less often than those with caudal lesions. The frequencies of dysphagia (P < 0.01), dysarthria (P < 0.01) and bilateral trigeminal sensory pattern (P < 0.05) were significantly different among horizontal subtypes in that these symptoms were frequent in patients with "large type" as compared with those with lateral type lesions. Angiograms performed in 123 patients showed vertebral artery (VA) disease in 67% and posterior inferior cerebellar artery (PICA) disease in 10%. The presumed pathogenetic mechanisms included large vessel infarction in 50%, arterial dissection in 15%, small vessel infarction in 13% and cardiac embolism in 5%. Dissection occurred more often in patients with caudal (versus rostral) lesions (P < 0.01), whereas dorsal type infarcts (versus other types) were related more often to cardiogenic embolism and normal angiogram findings (P < 0.05, each). Patients with isolated PICA disease (versus those with VA disease) more often had cardiogenic embolism (P < 0.05) and less often had dissection (P < 0.01). It is concluded that rostro-caudal and horizontal classification of MRI helps us to understand the clinical and, partly, the aetiopathogenetic aspect of the heterogeneous LMI syndrome.
Jong S Kim
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Publication Detail:
Type:  Journal Article     Date:  2003-05-21
Journal Detail:
Title:  Brain : a journal of neurology     Volume:  126     ISSN:  0006-8950     ISO Abbreviation:  Brain     Publication Date:  2003 Aug 
Date Detail:
Created Date:  2003-07-15     Completed Date:  2003-09-16     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0372537     Medline TA:  Brain     Country:  England    
Other Details:
Languages:  eng     Pagination:  1864-72     Citation Subset:  AIM; IM    
Department of Neurology, Asan Medical Center, Song-Pa PO Box 145, Seoul 138-600, South Korea.
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MeSH Terms
Acute Disease
Aged, 80 and over
Lateral Medullary Syndrome / classification,  etiology,  pathology*
Magnetic Resonance Imaging
Medulla Oblongata / pathology
Middle Aged
Retrospective Studies
Risk Factors
Sensation Disorders / etiology

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