Medulla D R B HAV IN J

Oblongata PAT E L
SR
N E UROLOGY
GMC
KOTA
 Anatomy
3Cm long.
Located at the caudal portion of brainstem
Upper limit is cerebello-pontine angle
Transverse plane that above C1 (suboccipital n)
intersects upper border of atlas dorsally and
centre of dens ventrally marks lower limit
Anatomy
The lower end which contains the upward
continuation of the central canal of the
spinal cord is the ‘closed part of the medulla’

The upper end, where the canal comes to

the surface as the lower part of the floor of
the fourth ventricle, is the ‘open part’
External
Anatomy
External Anatomy
Dorsal aspect
 Internal anatomy(open
part)
Internal
anatomy(closed part)
 internal medulla blood supp ly
PICA
anterolateral system
- -·.-. . " " "
t r l' l d f t n d , . O Uf

s .o . .- ... -;:;

posterior spinal artery

posterior territory
....,.
.,..
./
·
,

gracile tubercle and nucleus vs ,.,

cuneate tubercle and nucleus ...
vertebral artery
olive
inferior olivary nuclei
lateral te" itory

vs AS
A
rostral medulla
--.,-
. . .. . . . . .
.

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··-
Postenorln lenor
anterior spinal artery medial territory cerebellar atlery (PICA)

pyramid MypoolDN nlldous

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medial lemniscus
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Vertebral
Antenor spinal
.....

·-.....
ortery (ASA) artery (VA)
a ,...,,,....

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caudal medulla ....,,
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het - -
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 Medial medullary
syndrome(dejerine
 Ipsilateral paresis and atrophy of syndrome)
the
tongue
 Contralateral hemiplegia
 Contralateral loss of position
and vibration sense
 Occasionally upbeat nystagmus

 Other variants:-
 Sparing of hypoglossal nerve
 Crossed motor hemiplegia
 Pure motor hemiplegia
 Medial medullary
syndrome(dejerine
syndrome)
 Which artery?:-- ant spinal and vertebral
artery
 Etiology:-
 Atherosclerotic
 Vertebrobasilar dissection
 Embolism
 Meningovascular syphilis
 Lateral medullary
syndrome(wallenberg
syndrome)
Ipsilateral face hypalgesia
and thermoanaesthesia
Contralateral trunk and extremity
hypalgesia and thermoanaesthesia
Ipsilateral palatal, pharangyal and vocal
cord paralysis
Ipsilateral horner syndrome
Vertigo, nausea and vomiting
Ipsilateral cerebellar signs
Occasionally hiccups
 Lateral medullary
syndrome(wllenberg
Rare manifestations:- syndrome)
 Ocular abnormalities:-
 Dysfunction of ocular alignment:
Loss of taste sensation  Skew deviation
Inability to sneeze  Environmental tilt
 See saw nystagmus
Autonomic dysfunction  Nystagmaus:
Transient urinary  Horizontal or torsional
retention  Mixed
 Eyelid nystagmus
Pure sensory stroke  Abnormalities of saccades and
pursuit:-
Poststroke facial pain
 Lateral medullary
syndrome(wallenberg
syndrome)
Artery involved:- vertebral or PICA
Etiology:-
Vascular (atherosclerosis>dissection>small vessel dz>cardioembolism)
Demyelination
Neoplasm( metastasis)
Abscess
Hematoma
Trauma
Post surgery
 Other syndromes
Babinski- nageotte syndrome:-
Combination of medial and lateral medullary syndrome
Also known as hemimedullary syndrome and reinhold syndrome
Secondary to occlusion or dissection of intracranial vertebral artery

Avelis syndrome(laryngeal hemiplegia):-

Ipsilateral palatopharyngeal paresis with contralateral hemiplegia
Due to atherosclerosis of distal branch of vertebral artery
Complication of borreliosis
 Other syndromes
Opalski syndrome(submedullary):-
Ipsilateral hemiplegia with lateral medullary syndrome
Caudal extension of lesion involving CST after decussation
Due to vertebral artery occlusion

Lateral pontomedullary syndrome:-

Lateral medullary syndrome + 7th and 8th CN
Lower pontine bleed
 Other syndromes
Isolated vertigo due to medial branch of PICA
Glioma in tegmentum result in medullary satiety.
Lesion Obex can lead to neurogenic pulmonary edema.
Area postrema syndrome in NMO.
 MCQ

Left medial medullary

syndrome
 MCQ
60 yr old male pt k/c/o DM and HTN presented with sudden onset
contralateral hemiparesis with loss of vibration and position sense.
Which artery is involved in this case?

A. basilar art.
B. Vertebral Art.
C. anterior spinal Art.
D. PICA
 MC
55 yr old female patient presented with sudden onset vertigo with
vomiting and imbalance while Qwalking with occasional coughing
while taking food. On examination patient had ipsilateral cerebellar
sign with horner syndrome and decrease face pain sensation with
contralateral trunk and extremity thermoanesthesia. Location of
lesion?
A. pontomedullary junction
B. rostral lateral medulla
C. caudal lateral medulla
D. hemimedullary syndrome
 MCQ
Pt is having lateral medullary syn + ipsilateral hemiparesis. Which
syndrome???
A. Dejerine
B. Wallenberg
C. Avelis
D. Opalski
Thank you