2007 Volume 11 Issue 3 Pages 195-203
We report two cases of lateral medullary infarction (LMI) whose bolus was predominantly passed on the affected side at the cricopharyngeal portion on videofluorography. Both cases had a very similar lesion and similar atypical symptoms, Therefore, we considered the relationship between the lesion and symptoms of these cases.
Case one was a 62-year-old man whose MRI showed a lesion in the left lateral medulla (pontomedullary junction). His chief complaint was not being able to swallow saliva. Perception of pain and temperature was decreased on the entire right side of the face. Central facial nerve palsy was also observed on the left side. Oral feeding started again 12 days after the onset.
Case two was a 58-year-old man. After balloon angioplasty for severe stenosis of vertebral artery, he displayed severe dysphagia and inability to swallow saliva, central facial nerve palsy on the right side and hoarseness. Perception of pain and temperature was disturbed on left-side limbs, body and face. MRI on the day after the operation showed an infarction in the right lateral medulla (pontomedullary junction) and right cerebellum. He began oral feeding again after approximately one month.
MRI revealed a lesion in the upper lateral medulla in both cases. These cases with unilateral sensory defects were diagnosed as having involvement of the lateral spinothalamic tract and the ventral trigeminothalamic tract were implicated on clinical grounds. Concerning the central facial nerve palsy, we thought that some of the axons of the corticobulbar tract descending further ipsilaterally were damaged after decussation forward of the contralateral facial nucleus. The details of how the bolus passed on the affected side were unclear, but there was a possibility of some causal relation between the upper medullary lesion, and a bolus had predominantly passed on the affected side at the cricopharyngeal portion in these cases, because of lesion extensions were very similar. Therefore, perhaps the bolus laterality in these cases was one of the symptoms of LMI.
In a further study, we need to conduct a more detailed examination from various aspects about the relationship between laterality of bolus passage and medullary lesion.
