NDLI: Medial medullary infarction: clinical, imaging, and outcome study in 86 consecutive patients.

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Medial medullary infarction: clinical, imaging, and outcome study in 86 consecutive patients.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Han, Young S. Kim, Jong S.
Description	Country affiliation: South Korea Author Affiliation: Kim JS ( Stroke Center and Department of Neurology, University of Ulsan, Asan Medical Center, Seoul, South Korea. jongskim@amc.seoul.kr)
Abstract	BACKGROUND AND PURPOSE: Clinical-imaging correlation and long-term clinical outcomes remain to be investigated in medial medullary infarction (MMI). METHODS: We studied clinical, MRI, and angiographic data of 86 consecutive MMI patients. The lesions were correlated with clinical findings, and long-term outcomes, divided into mild and severe (modified Rankin scale >3), were assessed by telephone interview. Central poststroke pain (CPSP) was defined as persistent pain with visual numeric scale > or = 4. RESULTS: The lesions were located mostly in the rostral medulla (rostral 76%, rostral+middle 16%), while ventro-dorsal lesion patterns include ventral (V, 20%), ventral+middle (VM, 33%), and ventral+middle+dorsal (VMD, 41%). Clinical manifestations included motor dysfunction in 78 patients (91%), sensory dysfunction in 59 (73%), and vertigo/dizziness in 51 (59%), each closely related to involvement of ventral, middle, and dorsal portions, respectively (P<0.001, each). Vertebral artery (VA) atherosclerotic disease relevant to the infarction occurred in 53 (62%) patients, mostly producing atheromatous branch occlusion (ABO). Small vessel disease (SVD) occurred in 24 (28%) patients. ABO was more closely related to VMD (versus V+VM) than was SVD (P=0.035). During follow-up (mean 71 months), 11 patients died, and recurrent strokes occurred in 11. Old age (P=0.001) and severe motor dysfunction at admission (P=0.001) were factors predicting poor prognosis. CPSP, occurring in 21 patients, was closely (P=0.013) related to poor clinical outcome. CONCLUSION: MMI usually presents with a rostral medullary lesion, with a good clinical ventro-dorsal imaging correlation, caused most frequently by ABO followed by SVD. A significant proportion of patients remain dependent or have CPSP.
ISSN	00392499
e-ISSN	15244628
Journal	Stroke
Issue Number	10
Volume Number	40
Language	English
Publisher	Lippincott Williams & Wilkins (on behalf of the American Heart Association)
Publisher Date	2009-10-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Brain Stem Infarctions Pathology Medulla Oblongata Blood Supply Vertebral Artery Arterioles Physiopathology Mortality Causality Cerebral Angiography Disability Evaluation Magnetic Resonance Imaging Movement Disorders Etiology Prognosis Recovery Of Function Physiology Recurrence Sensation Disorders Vertigo Research Support, Non-u.s. Gov't Discipline Cardiology
Content Type	Text
Resource Type	Article
Subject	Cardiology and Cardiovascular Medicine Neuroscience Advanced and Specialized Nursing Neurology (clinical)

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