Lateral medullary infarction with a large, vertically extending lesion and early onset central respiratory failure

Abstract

A 75-year-old man suddenly developed vertigo and gait disturbance, and was taken to our hospital by ambulance. On arrival, hypercapnia was observed. Neurological examination revealed dysarthria, horizontal gaze-evoked nystagmus, left facial paralysis, dysphagia, left curtain sign, hyperesthesia of the left side of the face and the right side of the body, left cerebellar ataxia, and left Horner syndrome. Brain magnetic resonance imaging revealed lateral medullary infarction with a large lesion extending vertically from the left lateral medulla to the dorsal part of the left pontomedullary junction. Magnetic resonance angiography showed occlusion of the left vertebral artery. Approximately 9 hours after onset, he developed aspiration pneumonia, and about 24 hours later, he suddenly developed respiratory arrest, requiring mechanical ventilation. In cases of lateral medullary infarction involving lesions extending more rostrally than the obex level, respiratory control mechanisms can be compromised and the risk of aspiration can be increased. This case exhibited a vertically extensive lesion, and presented with severe early onset central respiratory impairment and aspiration pneumonia. We consider our case as valuable for understanding the mechanism of respiratory failure associated with lateral medullary infarction.