Korean J Stroke.  2011 Dec;13(3):137-139. 10.5853/kjs.2011.13.3.137.

A Case of Ipsilateral Hemiparesis in Lateral Medullary Infarction: As a Warning Sign of Acute Progression of Vertebral Artery Thrombosis

• Hur TH
• Lee DH
• Park JH

• KMID: 1996985
• DOI: http://doi.org/10.5853/kjs.2011.13.3.137

Abstract

A 70-year-old man presented with acute dysarthria and dizziness. He denied any history of trauma or cervical manipulations within several weeks before symptom onset. We could make a presumptive diagnosis of left Wallenberg syndrome through the results of neurologic examination, which include left limb ataxia, alternating hyp(o)esthesia, spontaneous nystagmus to right side, and left side Honer's syndrome. Initial diffusion weighted imaging performed at admission showed small and discrete high signal lesions in left lateral medulla, left cerebellar hemisphere, and bilateral occipital areas. Contrast enhanced MRA demonstrated a filling defect in long segment of distal left vertebral artery. On 4th days after symptom onset, the patient developed a severe form of ipsilateral hemiparesis. Follow-up brain MRI showed a downward extension of the initial ischemic lesion in upper medulla to upper cervical region. This case suggests that a severe form of ipsilateral hemiparesis may be complicated in the clinical setting of acute lateral medullary infarction with vertebral artery occlusion.

Keyword

Lateral medullary infarction; Ipsilateral hemiparesis; Vertebral artery occlusion

MeSH Terms

Aged
Ataxia
Brain
Diffusion
Dizziness
Dysarthria
Follow-Up Studies
Humans
Infarction
Lateral Medullary Syndrome
Neurologic Examination
Paresis
Thrombosis
Vertebral Artery