Abstract
A 61-year-old male suddenly felt a shooting pain on the left side of his neck when he twisted the neck, and suddenly experienced urinary retention. On admission, we observed few obvious focal neurological signs except for an unsteady gait. Magnetic resonance imaging revealed an acute infarct in the left medulla, which extended posteriorly from the inferior olivary nucleus. Left vertebral angiogram revealed that the left posterior inferior cerebellar artery (PICA) territory was supplied by the right anterior inferior cerebellar artery–PICA trunk and a collateral branch originating from the extracranial left vertebral artery. Cystometry revealed normal voiding sensation and relatively high intravesical pressure during voiding effort. On the 9th day of admission, he was able to void normally without residual urine. He was discharged on the 13th day; he has not shown any signs of recurrence of lower urinary tract symptoms. Lower urinary tract dysfunction (LUTD) associated with medullary infarction is rare. At the medulla level, the descending tract from the pontine micturition center (PMC) is assumed to lie posterior to the inferior olivary nucleus. In our patient, the involvement of this tract might have caused LUTD. The important point in this case is that his medullary infarction developed mainly with LUTD. In contrast to previous reports, the lateral part of the medulla, which is supplied by PICA, was spared in our patient. This characteristic infarct distribution would explain the paucity of focal neurological findings in our patient.
