Following the vascular supply, two distinct clinical syndromes may be distinguished in case of ischemic lesions, being restricted either to the paramedian ventral parts of the medulla (“Dejerine syndrome”) ( 1) or to the (dorso-)lateral aspects of the medulla oblongata ( 2– 4). The human medulla oblongata is the most caudal brainstem area and is critically involved in various motor, sensory, and autonomic functions. This can be explained by lesions located too far caudally and too far ventrally to substantially affect the vestibular nuclei. Only those two patients with lesions affecting the rostral medulla oblongata demonstrated an ipsilaterally impaired aVOR.Ĭonclusions: While subtle ocular motor signs pointed to damage of the central–vestibular pathways in all 17 patients, aVOR deficits were infrequent, restricted to those patients with rostral medullary lesions and, if present, mild to moderate only.
On brain MRI, damage of the most caudal parts of the medial and/or inferior vestibular nucleus was noted in 13 patients. Head-shaking nystagmus was noted in seven subjects, ipsilesionally beating in six and down-beating in one. 3) and was accompanied by upbeat nystagmus in four patients. Spontaneous nystagmus ( n = 10/15 patients) was more often beating contralesionally than ipsilesionally (6 vs. vHIT showed mild-to-moderate aVOR impairments in three patients (ipsilesional = 1 ipsilesional and contralesional = 1 contralesional = 1). Results: Seventeen patients with LMS (age = 59.4 ± 14.3 years) were included. The lesion location/extension as seen on MRI was rated and involvement of the vestibular nuclei was judged. Video-oculography and video-based head-impulse testing (vHIT) was obtained and semicircular canal function was determined. Methods: Patients with MR-confirmed acute/subacute unilateral LMS from a stroke registry were included and a bedside neuro-otological examination was performed. Objective: We aimed to characterize the frequency and pattern of vestibular and ocular-motor deficits in patients with LMS. Thus, an impaired angular vestibulo-ocular reflex (aVOR) may be found if the vestibular nuclei are affected. 4Neurology, Cantonal Hospital of Baden, Baden, Switzerlandīackground: Lateral medullary stroke (LMS) results in a characteristic pattern of brainstem signs including ocular motor and vestibular deficits.
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