Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Lateral medullary infarction presenting with truncal lateropulsion and decreased pain and temperature sensation below T10 sensory level

Takahito Nishihira, M.D.1), Keisuke Suzuki, M.D., Ph.D.1), Hidehiro Takekawa, M.D., Ph.D.1), Toshiki Nakamura, M.D., Ph.D.2), Akio Iwasaki, M.D.1) and Koichi Hirata, M.D., Ph.D.1)

1)Department of Neurology, Dokkyo Medical University
2)Department of Neurology, Rehabilitation Amakusa Hospital

A 45-year-old man noted a tendency to fall to the left side on standing following headache and vomiting. Neurological findings were unremarkable except for truncal lateropulsion to the left side. Brain magnetic resonance imaging (MRI) showed a small infarct in the left inferolateral part of medulla. Clinical and imaging findings suggested vertebral artery dissection as the cause of stroke. On hospital day 6, the patient developed decreased pain and temperature sensation in the right side below T10 sensory level and decreased sweating on the left side of the face with miosis of the left pupil. Brain MRI revealed an expanded lesion of the left inferolateral part of medulla. In our patient, the involvement of the spinocerebellar tract and the lateral spinothalamic tract likely contributed to the development of truncal lateropulsion and sensory disturbance below thoracic levels, respectively. Our case is clinically important in understanding a correlation between clinical symptoms and lateral medullary lesions.
Full Text of this Article in Japanese PDF (3062K)

(CLINICA NEUROL, 54: 819|823, 2014)
key words: inferolateral medullary infarction, truncal lateropulsion, sensory level

(Received: 15-Feb-14)