The straight line from retro-olivary sulcus to median sulcus is a useful limit line associated with risk of intubation due to central hypoventilation in lateral medullary syndrome

Abstract

Background and Purpose: In patients with lateral medullary infarcts caused by posterior inferior cerebellar artery occlusion, central respiratory failure requiring intubation is a relatively rare condition without known risk factors. We found that the respiratory center is close to the straight line that connects the retro-olivary sulcus and the median sulcus, which we defined as the ROMS line. Herein, we examined the association of lateral medullary infarcts that cross the ROMS line with the requirement for intubation. Methods: We retrospectively studied 32 patients with lateral medullary infarction at our department from April 2006 to August 2023. Patients were divided into those without or with intubation. The background factors, neurological findings, imaging findings, and outcomes were compared between the two groups. Results: Six patients required intubation. Furthermore, these patients had lateral medullary infarcts that crossed the ROMS line. The intubated patients required more extended hospitalization periods and had poorer outcomes than those without intubation. Conclusion: Patients with lateral medullary infarcts that cross the ROMS line may require intubation. Clinicians should consider early tracheostomy for these patients to decrease in-hospital morbidity and mortality.