Hemimedullary Syndrome with Ipsilateral Sensorimotor Deficits

On admission, he complained of rightsided weakness, right facial palsy, dysarthria, and dysphagia. His blood pressure was 167/104 mm Hg, pulse rate was regular at 78/min and body temperature was 36.7 ° C. Physical examination showed no abnormality in the chest or abdomen. His mental state was alert. Neurologic examination demonstrated right upper, motor neuron-type facial palsy with dysarthria, dysphagia, and paralysis of the right tongue and palate. His right eye had left beating and upbeat nystagmus in horizontal and vertical planes, and he also showed right-sided head tilt, ocular tilt, lateropulsion and hypometric saccade to the right. In addition, he showed right hemiparesis (arm: MRC grade IV, leg: III), right-sided hyperalgesia and decreased perception of vibration sense, as well as increased deep tendon refl ex in the right arm and leg. His right limbs were ataxic and he could not stand without assistance. Brain magnetic resonance imaging with angiography was performed. Diffusionweighted imaging revealed a hyperintense lesion in the right dorsolateral medulla oblongata and FLAIR imaging showed a hyperintense lesion in the right medial and lateral medulla oblongata with extension of the lesion in the cervicomedullary junction Dear Sir, Hemimedullary syndrome has been introduced as Babinski-Nageotte syndrome or Reinhold syndrome with ischemic lesion in unilateral lateral and medial medulla oblongata [1–3] . The identity of hemimedullary stroke has remained controversial because both medial and lateral medullary infarctions rarely occur simultaneously and vascular supplies of the medial and lateral medulla usually differ [4, 5] . Rarely, the lower medullary lesion caused the symptoms of ipsilateral hemiparesis with sensory loss [6, 7] . Here we describe a patient with hemimedullary syndrome in conjunction with ipsilateral hemiparesis and sensory loss caused by ipsilateral, vertebral artery dissection. The ipsilateral motor weakness was evaluated by diffusion tensor imaging (DTI) and transcranial magnetic stimulation (TMS) study.