A blood thinner may be prescribed to a patient in order to break up the infarction and reestablish blood flow and to try to prevent future infarctions.
Other medications may be necessary in order to suppress high blood pressure and risk factors associated with strokes. Warfarin is used if atrial fibrillation is present. Long-term treatment generally involves the use of antiplatelets like aspirin or clopidogrel and statin regimen for the rest of their lives in order to minimize the risk of another stroke. Some studies have reported success in mitigating the chronic neuropathic pain associated with the syndrome with anti- epileptics such as gabapentin. In some cases, medication may be used to reduce or eliminate residual pain. In more severe cases, a feeding tube may need to be inserted through the mouth or a gastrostomy may be necessary if swallowing is impaired. Depressed mood and withdrawal from society can be seen in patients following the initial onslaught of symptoms. Treatment for lateral medullary syndrome involves focusing on relief of symptoms and active rehabilitation to help patients return to their daily activities.
Treatment for lateral medullary syndrome is dependent on how quickly it is identified. Standard stroke assessment must be done to rule out a concussion or other head trauma. Head Impulsive Nystagmus Test of Skew (HINTS) examination of oculomotor function is often performed, along with computed tomography (CT) or magnetic resonance imaging (MRI) to assist in stroke detection. Diagnosis is usually done by assessing vestibular-related symptoms in order to determine where in the medulla that the infarction has occurred. Since lateral medullary syndrome is often caused by a stroke, diagnosis is time dependent. The most commonly affected artery is the vertebral artery, followed by the PICA, superior middle and inferior medullary arteries. It is the clinical manifestation resulting from occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts, resulting in a typical pattern. Human brainstem blood supply description. Ipsilateral Horner's syndrome (ptosis, miosis, & anhidrosis) Ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis: dysphagia, hoarseness, absent gag reflex (efferent limb-CN X) Nucleus ambiguus - (which affects vagus nerve and glossopharyngeal nerve) - localizing lesion (all other deficits are present in lateral pontine syndrome as well)
Ipsilateral deficits in pain and temperature sensation from face Ipsilateral cerebellar signs including ataxia, dysmetria (past pointing), dysdiadochokinesiaĬontralateral deficits in pain and temperature sensation from body (limbs and torso) Vestibular system: Vomiting, vertigo, nystagmus Ĭlinical B1000 diffusion weighted MRI image showing an acute left sided dorsal lateral medullary infarct Based on location Features of lateral medullary syndrome Lateral medullary syndrome can also cause bradycardia, a slow heart rate, and increases or decreases in the patients average blood pressure. Other symptoms include: hoarseness, nausea, vomiting, a decrease in sweating, problems with body temperature sensation, dizziness, difficulty walking, and difficulty maintaining balance. Palatal myoclonus, the twitching of the muscles of the mouth, may be observed due to disruption of the central tegmental tract. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms that are similar to the symptoms caused by Horner's syndrome – such as miosis, anhidrosis and partial ptosis.
The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Slurred speech ( dysarthria), and disordered vocal quality ( dysphonia) are also common. This can be caused by the involvement of the nucleus ambiguus, as it supplies the vagus and glossopharyngeal nerves. Ĭommon symptoms with lateral medullary syndrome may include difficulty swallowing, or dysphagia. These vertigo spells can result in falling, caused from the involvement of the region of Deiters' nucleus. The nystagmus is commonly associated with vertigo spells. Some patients may walk with a slant or experience skew deviation and illusions of room tilt. Patients often have difficulty walking or maintaining balance ( ataxia), or difference in temperature of an object based on which side of the body the object of varying temperature is touching. The cross body finding is the chief symptom from which a diagnosis can be made. Specifically a loss of pain and temperature sensation if the lateral spinothalamic tract is involved. This syndrome is characterized by sensory deficits that affect the trunk and extremities contralaterally (opposite to the lesion), and sensory deficits of the face and cranial nerves ipsilaterally (same side as the lesion).