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Yamaoka Y, Kishishita S, Takayama Y, Okubo S. A Report of a Case Involving Body Lateropulsion with Numbness of the Ipsilesional Fingers Caused by a Small Infarction in the Dorsal Part of the Middle Medulla. Case Rep Neurol 2018; 10:54-59. [PMID: 29606953 PMCID: PMC5869568 DOI: 10.1159/000486892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 11/24/2022] Open
Abstract
Based on the complexity of functional anatomy, a small infarction in the medulla can produce various types of clinical symptoms or signs depending on the location of this infarction. We describe the case of a 46-year-old man who presented with sudden onset of body lateropulsion to the left side and numbness of the ipsilateral fingers. 3-tesla diffusion-weighted magnetic resonance imaging with a section thickness of 2 mm revealed a small infarction in the dorsal part of the left middle medulla. To our knowledge, this is the first case report describing vestibular dysfunction apparent upon otoelectrophysiological examination but without vestibular symptoms or signs except for body lateropulsion.
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Affiliation(s)
- Yumiko Yamaoka
- Department of Cerebrovascular Medicine, NTT Medical Center, Tokyo, Japan
| | - Sadahiro Kishishita
- Department of Otolaryngology, Head and Neck Surgery, NTT Medical Center, Tokyo, Japan
| | - Yohei Takayama
- Department of Cerebrovascular Medicine, NTT Medical Center, Tokyo, Japan
| | - Seiji Okubo
- Department of Cerebrovascular Medicine, NTT Medical Center, Tokyo, Japan
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Hu Y, Long X, Lyu H, Zhou Y, Chen J. Alterations in White Matter Integrity in Young Adults with Smartphone Dependence. Front Hum Neurosci 2017; 11:532. [PMID: 29163108 PMCID: PMC5673664 DOI: 10.3389/fnhum.2017.00532] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 10/19/2017] [Indexed: 12/24/2022] Open
Abstract
Smartphone dependence (SPD) is increasingly regarded as a psychological problem, however, the underlying neural substrates of SPD is still not clear. High resolution magnetic resonance imaging provides a useful tool to help understand and manage the disorder. In this study, a tract-based spatial statistics (TBSS) analysis on diffusion tensor imaging (DTI) was used to measure white matter integrity in young adults with SPD. A total of 49 subjects were recruited and categorized into SPD and control group based on their clinical behavioral tests. To localize regions with abnormal white matter integrity in SPD, the voxel-wise analysis of fractional anisotropy (FA) and mean diffusivity (MD) on the whole brain was performed by TBSS. The correlation between the quantitative variables of brain structures and the behavior measures were performed. Our result demonstrated that SPD had significantly lower white matter integrity than controls in superior longitudinal fasciculus (SLF), superior corona radiata (SCR), internal capsule, external capsule, sagittal stratum, fornix/stria terminalis and midbrain structures. Correlation analysis showed that the observed abnormalities in internal capsule and stria terminalis were correlated with the severity of dependence and behavioral assessments. Our finding facilitated a primary understanding of white matter characteristics in SPD and indicated that the structural deficits might link to behavioral impairments.
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Affiliation(s)
- Yuanming Hu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Xiaojing Long
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hanqing Lyu
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
| | - Yangyang Zhou
- Department of Radiology, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianxiang Chen
- Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen, China
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Katsumata M, Oki K, Nakahara J, Izawa Y, Abe T, Takahashi S, Suzuki N. Ipsilateral Facial Tactile Hypesthesia in a Patient with Lateral Medullary Syndrome. J Stroke Cerebrovasc Dis 2015; 24:e315-7. [DOI: 10.1016/j.jstrokecerebrovasdis.2015.07.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 10/23/2022] Open
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Kk P, R K, P C, Aiyappan SK, N D. A Rare Variant of Wallenberg's Syndrome: Opalski syndrome. J Clin Diagn Res 2014; 8:MD05-6. [PMID: 25177595 DOI: 10.7860/jcdr/2014/9547.4626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/09/2014] [Indexed: 11/24/2022]
Abstract
Lateral Medullary Syndrome (LMS) is a well-documented vascular syndrome of the posterior circulation territory. This syndrome is easily localised because of characteristic presentation, unique territory of blood supply and very small area of involvement. We present a case of Wallenberg's syndrome which did not have all the classical components of the syndrome, like Horner's syndrome. Opalski syndrome is a rare variant of Wallenberg syndrome, where lateral medullary syndrome is associated with ipsilateral hemiparesis. This case report highlights how differential involvement of the lateral part of medulla can result in varied presentation.
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Affiliation(s)
- Parathan Kk
- Assistant Professor, Department of General Medicine, Saveetha Medical College & Hospital, Saveetha University , Saveetha Nagar, Thandalam, Chennai, Tamilnadu, India
| | - Kannan R
- Associate Professor, Department of General Medicine, Saveetha Medical College & Hospital, Saveetha University , Saveetha Nagar, Thandalam, Chennai, Tamilnadu, India
| | - Chitrambalam P
- Professor, Department of General Medicine, Saveetha Medical College & Hospital, Saveetha University , Saveetha Nagar, Thandalam, Chennai, Tamilnadu, India
| | - Senthil Kumar Aiyappan
- Associate Professor, Department of Radiodiagnosis and Imaging, Saveetha Medical College & Hospital, Saveetha University , Saveetha Nagar, Thandalam, Chennai, Tamilnadu, India
| | - Deepthi N
- Junior Resident, Department of General Medicine, Saveetha Medical College & Hospital, Saveetha University , Saveetha Nagar, Thandalam, Chennai, Tamilnadu, India
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Sameshima T, Morita A, Yamaoka Y, Ichikawa Y. Ipsilateral sensorimotor deficits in lateral medullary infarction: a case report. J Stroke Cerebrovasc Dis 2012; 23:191-3. [PMID: 23219198 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 10/25/2012] [Accepted: 11/07/2012] [Indexed: 11/29/2022] Open
Abstract
The patient, a 32-year-old man, presented with sudden onset of occipital headache, vertigo, dysarthria, gait ataxia, right Horner syndrome, numbness of the right hand, and mild right hemiparesis. On magnetic resonance imaging, an acute small infarction was located on the right side of the caudal medulla extending dorsomedially. Magnetic resonance angiography showed severe right vertebral artery stenosis. Lateral medullary infarction associated with ipsilateral sensorimotor deficits in the limb is very rare, and the lesion probably involved the ipsilateral dorsal column or decussating lemniscal fibers and corticospinal fibers caudal to the pyramidal decussation or compression of the decussation.
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Affiliation(s)
- Tetsuro Sameshima
- Department of Neurosurgery and Stroke Center, NTT Medical Center Tokyo, Japan.
| | - Akio Morita
- Department of Neurosurgery and Stroke Center, NTT Medical Center Tokyo, Japan
| | - Yumiko Yamaoka
- Department of Neurosurgery and Stroke Center, NTT Medical Center Tokyo, Japan
| | - Yasumitsu Ichikawa
- Department of Neurosurgery and Stroke Center, NTT Medical Center Tokyo, Japan
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Shibata K, Otuka K, Nishimura Y, Kondo H, Ikeda N, Iwata M. Isolated limb sensory disturbance accompanied with sudden deafness from vertebral artery dissection: a case report. J Neurol Sci 2007; 263:180-3. [PMID: 17599360 DOI: 10.1016/j.jns.2007.05.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 05/23/2007] [Indexed: 11/17/2022]
Abstract
A 52-year-old male presented with right sudden deafness and left isolated limb sensory disturbance following posterior neck pain. An examination revealed a mild degree of right sensory neural hearing loss and decreased pain and thermal sensation in the left side below the L3 level. Brain MRI showed a small lesion in the midlateral portion of the right middle-rostral medulla. The combination of the image findings suggests a right lateral medullary infarction caused by a vertebral artery (VA) dissection. In our case, the fibers carrying the modalities of the lateral spinothalamic tract restricted to below the L3 level, sparing other sensations, suggest a selective involvement. This finding suggests that sensory dermatomal representation in the modality may be preserved at least up to the level of the medulla oblongata. Moreover, in our case, the small emboli originating from the dissected VA possibly caused a small selective cochlear infarction. This type of embolism may give rise to various combinations of symptoms depending on the branches involved. For patients with an acute onset of headache or neck pain who present with isolated limb sensory disturbance accompanied by sudden deafness, even without the classical brainstem signs, a VA dissection and medullary infarction should therefore be considered.
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Affiliation(s)
- K Shibata
- Department of Medicine, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, 116-8567, Japan.
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Vuillier F, Tatu L, Dietsch E, Medeiros E, Moulin T. Pontomedullary sulcus infarct: a variant of lateral medullary syndrome. J Neurol Neurosurg Psychiatry 2006; 77:1276-8. [PMID: 17043294 PMCID: PMC2077395 DOI: 10.1136/jnnp.2006.099499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
With the advent of magnetic resonance imaging (MRI) technology, it is now possible to identify and determine the precise location of medullary infarcts. The lateral part of the medulla is most commonly affected by infarction. Classifications of lateral medullary infarcts are usually based on anatomical data, using rostrocaudal and dorsoventral axes to establish correlations with clinical symptoms. Different subtypes of lateral medullary syndrome, depending on location, shape and size of the infarct, have been described in the literature. We report a rare case of a patient presenting with an unusual clinical picture in relation to an infarct specifically located in the lateral part of the pontomedullary sulcus.
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Affiliation(s)
- F Vuillier
- Fédération des Sciences Neurologiques, Centre Hospitalier Universitaire Jean Minjoz, Besançon, France.
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Abstract
The patient, the author (S.K.), is a 67-year-old male. He has the typical dissociated pain, altered temperature sensation and ataxia often encountered by patients with lateral medullary infarction. This started at the time of his admission to hospital. Several weeks after discharge, he experienced the withdrawal reaction to high temperature, first mentioned by Rousseaux (Stroke 30 (1999) 2223), and movement allodynia as described by Bowsher (J Neurol Neurosurg Psychiatry 61 (1996) 62). The article describes his personal experience of the symptoms of central post-stroke pain and allodynia. A difference between muscle allodynia and conventional allodynia caused by dermal stimulation is proposed. Follow-up evaluation of sensory symptoms that appear several weeks after discharge is essential to ensure measures to alleviate them are provided.
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Affiliation(s)
- Shuji Kamano
- Kami-Itabashi Hospital, 4-36-9 Tokiwadai, Itabashi-ku, Tokyo, Japan.
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