However, on 1 day post-hospital admission, a small acute infarct in the posterolateral aspect of the left medulla was detected by DWI. In an emergency imaging examination, the results of computed tomography (CT) and diffusion weighted imaging (DWI) were negative. Thorough somatosensory tests, personal descriptions of symptoms, and electrophysiological quantification of similar cases are needed to improve our understanding of the neurological separation of the sensations of pain and temperature at the medullary levelĪ case of a 64-year-old female with acute-onset vertigo, nausea, and vomiting. The chronological changes in the patient's introspection regarding impairment of thermoception and the results of detailed somatosensory tests, including thermal sense, are shown in this report. Palatal myoclonus may be observed due to disruption of the central tegmental tract.Ī 53-year-old female patient presenting with impaired Thermoception on the left half of her body, from the neck down, following a small infarction of the right midlateral medulla. Onset is usually acute with severe vertigo. 36 Two patients with an occlusion of the hypoplastic VA terminating in PICA developed different patterns of nystagmus. Nystagmus and vertigo may result in falling, caused from involvement of the region of Deiters' nucleus and other vestibular nuclei. As the PICA usually supply the dorsolateral medulla and inferior cerebellum, the vertigo and nystagmus in these patients may be ascribed to transient ischemia of these structures. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms analogous to Horner syndrome. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation on the opposite side of the body. Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex. This crossed finding is diagnostic for the syndrome.Ĭlinical symptoms include swallowing difficulty, or dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia, and possibly palatal myoclonus.Īffected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, as well as slurred speech (dysarthria) and disordered vocal quality (dysphonia). Specifically, there is a loss of pain and Thermoception on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct.
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