Lateral and medial medullary infarction - A comparative analysis of 214 patients

Background and Purpose - No large-scale study has ever compared the clinical and radiological features of lateral medullary infarction (LMI) and medial medullary infarction (MMI). The aim of this study was to investigate them through the use of cooperatively collected cases. Methods - Medical information on all patients from 1996 to 2000 with medullary infarction (MI) proven by brain MR images at 35 stroke centers in the Tohoku district, Japan, was collected, and their clinical and radiological features were analyzed. Results - A total of 214 cases of MI were registered. They included 167 cases (78%) of LMI, 41 (19%) of MMI, and 6 (3%) of LMI plus MMI. The mean age of onset and the male-to-female ratio were 60.7 years and 2.7: 1 in LMI and 65.0 years and 3.6: 1 in MMI, respectively. The middle medulla was most frequently affected in LMI, and the upper medulla was most frequently affected in MMI. Dissection of the vertebral artery was observed in 29% of LMI and 21% of MMI. Prognosis, assessed by the Barthel Index, was favorable in both LMI and MMI. Diabetes mellitus was more frequently associated with MMI than with LMI. Conclusions - The present study surveyed a large number of MI cases and revealed that ( 1) the mean age of onset of MMI is higher than that of LMI, ( 2) the dissection of the vertebral artery is an important cause not only of LMI but also of MMI, and ( 3) diabetes mellitus is frequently associated with MMI.