Atypical Presentation of Medullary Syndrome in a Young Woman
Geetanjali Sharma *
Department of Physiology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, University of Health Sciences, Rohtak, Haryana, India.
*Author to whom correspondence should be addressed.
Abstract
Wallenburg syndrome occurs due to damage to lateral segment of the medulla. Medial medullary syndrome occurs due to damage to upper portion of the medulla. I report a case of a 30 years old woman diagnosed with medullary syndrome [both medial & lateral features] in absence of CT scan findings sent to the department of Physiology for electrophysiological tests like nerve conduction studies, blink reflex, brainstem auditory evoked potential (BERA) & visual evoked potential (VEP). She had loss of sensations on the ipsilateral half of face (right), hemisensory loss on contralateral trunk & extremities, headache, contralateral hemiparesis (left), ipsilateral lingual paresis with atrophy, fibrillations with contralateral positive Babinski’s sign. The electrophysiological tests showed decrease in conduction velocity of right facial nerve, left tibial & peroneal nerves with decreased amplitude. The nerve conduction studies of median nerve (both motor & sensory) were normal. In blink reflex, latency of R2 ipsilateral & R2 contralateral of supraorbital nerves were increased on right side. There were increased latencies of waves II, III, IV & V of BERA & increased P100 latencies in VEP.
The results of the electrophysiological tests of the patient showed that she had features of both medial & lateral medullary syndrome suggesting a lesion of both upper & middle medulla. The CT scan in this case was normal but conduction of MRI & CT guided angiography of posterior cerebral & vertebral arteries could have further localized the lesion causing this mixed symptomology.
Keywords: Medullary syndrome, electrophysiological tests, BERA, VEP, blink reflex