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Medial Medullary Syndrome Definition, Symptoms, Causes, Treatment

   

Medial medullary syndrome have many other names like lower alternating hemiplegia, hypoglossal alternating hemiplegia, inferior alternating syndrome and dejerine syndrome. Joseph jules dejerine was the scientist who 1st described medial medullary syndrome so dejerine syndrome is the most common name used for medial medullary syndrome. It is a type of alternating hemiplegia in which thrombotic or embolic occlusion occurs in the anterior spinal artery. Anterior spinal artery initiates from vertebral basilar artery and ends in medial part of medulla oblongata. So, occlusion in anterior spinal artery leads to infarction in the medial part of medulla oblongata.


It is a rare syndrome and characterize as contralateral hemiplegia and ipsilateral hypoglossal palsy. In simple words, patient is half paralyzed with half sided sensory loss opposite to the affected side of medulla oblongata. Loss of tongue control and atrophy occurs on the same side of affected medulla oblongata. CN Xll nucleus is involved. The main symptoms of medial medullary syndrome are nausea, dizziness, vertigo and limb ataxia to the opposite side of affected medulla oblongata. Medial medullary syndrome is different from lateral medullary syndrome because of the area of medulla oblongata involved in infarction. The nerve supply is also different.

Medial Medullary Syndrome Definition, Symptoms, Causes, Treatment

Medial Medullary Syndrome Symptoms


The symptoms of medial medullary syndrome are visible. One side which is opposite to the affected medulla oblongata is paralyzed except face. Motor function pathway is disturbed. Patient cannot touch, feel and change his position willingly from paralyzed side. The motor functioning of whole body is impaired contralateraly but facial nerves are impaired ipsilateraly I.e. eyes, nose and tongue movement is impaired on the same side of affected medulla oblongata. Mainly hypoglossal nerve is involved which supplies signals to tongue. Other symptoms involve dizziness, nausea, vomiting,  vertigo and limb ataxia on the opposite side of affected medulla oblongata.

Medial Medullary Syndrome Causes


Anterior spinal artery is the main artery responsible for this syndrome. It initiates from vertebral or proximal basilar artery and ends in medial part of medulla oblongata. When problem occurs in anterior spinal artery, it affects medullary pyramid, medial lemniscus and hypoglossal nerve fiber ipsilateraly. Basically thrombosis or embolism in anterior spinal artery leads to decreased blood and oxygen supply. And as a result infarction occurs in medial part of medulla oblongata. Patient's half body is affected mainly because it is a type of alternating hemiplegia in which one side of body is affected alternatively.

Medial Medullary Syndrome Treatment


It is a stroke syndrome for which there is no definite treatment designed yet. Because it is hard to reverse stroke syndromes. But according to its cause, the blood thinning agents may be prescribed to remove embolism and thrombosis. But medications used must have ability to pass blood brain barrier. Other than this, medications are also prescribed to combat signs and symptoms of medial medullary syndrome. Proper physical therapy is required to improve movement of paralyzed limbs. There are some specific exercises which helps a lot in continuation motor functioning of whole body including face.

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