Türk Beyin Damar Hast Derg. 2001; 7(2): 57-61

Medýal medullary infarction: six cases

Nerses Bebek, Rezzan Tuncay, Yakup Krespi, Bekir Tuðcu, Oðuzhan Çoban, Sara Bahar
Istanbul University Istanbul Medical Faculty, Department Of Neurology, Ýstanbul

Medial medullary infarcts (MMI) constitute less than 1% of all posterior circulation ischemic strokes. There are few cases reported in the litterature but with more widespread use of magnetic resonnance imaging, this syndrome is now more readily recognized. The classical clinical triad consists of ipsilateral lingual paresis, contralateral hemiparesis and decreased vibration and position sense. In this study 6 cases with medial medullary infarction on MRI registered in Istanbul Medical Faculty Stroke Databank between 1994-2000 were evaluated. Contralateral hemiparesis was found in all patients and in four of them there was ipsilateral central facial paresis. In five cases deep and superficial sensory loss were found on the paretic side. One patient had ipsilateral hypoglossal nerve paresis. The infarct was situated in all cases on upper-anteromedial portion of the medulla, lateral medullary region and lower pontine segments were involved each in one patient. Doppler ultrasonographic studies revealed findings compatible with stenosis/occlusion of ipsilateral vertebral artery in two cases and of both vertebral arteries in two other cases. These findings were comparable with MR angiographic findings. Classical MMI findings were not detected in any patient. The most important cause was the atherotrombotic occlusion of the vertebral artery. Two patients presented with lacunar syndrome findings. For patients having a lacunar syndrome or a clinical presentation different from the classical triad of MMI, doppler ultrasonography could reveal a vertebral artery stenosis/occlusion and thus point to an infratentoriel pathology. In this condition MRI could be helpful to identify the MMI and to apply the favorable treatment.

Keywords: Medial medullary infarction, vertebral artery desease, Doppler ultrasonography.

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Medyal bulber infarkt: altý olgu

Nerses Bebek, Rezzan Tuncay, Yakup Krespi, Bekir Tuðcu, Oðuzhan Çoban, Sara Bahar
Ýstanbul Üniversitesi Ýstanbul Týp Fakültesi Nöroloji Anabilim Dalý, Ýstanbul

Medyal bulber infarkt (MBÝ) arka sistem iskemik inme olgularýnýn % 1'den azýný oluþturur. Literatürde az sayýda vaka bildirilmiþ olmasýna karþýn, MR’ýn rutin uygulamaya girmesi ile giderek daha çok sayýda vaka tanýnmaya baþlanmýþtýr. MBÝ’ýn ipsilateral dil, kontralateral hemiparezi ve derin duyu kusurundan oluþan klasik triadý vardýr. Bu çalýþmada 1994-2000 yýllarý arasýnda Ýstanbul Týp Fakültesi Ýnme Veri Bankasýna kayýtlý, kranyal MR incelemelerinde, MBÝ’ý olan 6 hasta deðerlendirildi. Tüm olgularda karþý beden yarýsýnda hemiparezi, dördünde zaaf ile ayný tarafta santral tipte yüz felci vardý. Olgularýn beþinde hemiparezi ile ayný tarafta derin ve yüzeyel duyu kusuru saptandý. Ýpsilateral hipoglossus felci tek olguda gözlendi. Ýnfarkt tüm olgularda bulbusun üst-anteromedyal bölgesinde olup, bir olguda lateral bulber, diðer bir olguda alt pons bölgesini de içermekteydi. Doppler-ultrasonografi incelemesinde 2 olguda ipsilateral, iki olguda iki yanlý vertebral arter darlýk/týkanma bulgularý saptandý. MR anjiyografi incelemeleri Doppler-ultrasonografi bulgularý ile uyumlu idi. Olgularýn hiçbirinde klasik MBÝ bulgularý saptanmamýþtýr. Ýnfarkta yol açan en önemli neden vertebral arterin aterotrombotik týkanmasýdýr. Ýki olguda laküner sendrom bulgularý vardýr. Muayene bulgularý klasik medyal bulber infarkt ile baðdaþmayan veya laküner sendrom ile baþvuran hastalarda, Doppler-ultrasonografi ile vertebral arterlerde darlýk/týkanma varlýðýný gösteren bulgularýn saptanmasý dikkati infratentoryel bölgeye yöneltebilir. Bu durumda yapýlacak olan beyin MR incelemesi, medyal bulber infarkt olgularýnýn tanýnmasýna ve uygun yöntemlerle tedavi edilmesine yardýmcý olabilir.

Anahtar Kelimeler: Medyal bulber infarkt, vertebral arter hastalýðý, Doppler-ultrasonografi.

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