Medial medullary syndrome is most frequendy the result of occlusion of the vertebral artery or the anterior spinal artery (Figure IV-5-14). Medial medullary syndrome presents with a lesion of the hypoglossal nerve as the cranial nerve sign and lesions to both the medial lemniscus and the corticospinal tract. Corticospinal tract lesions produce contralateral spastic hemiparesis of both limbs.
Medial lemniscus lesions produce a contralateral deficit of proprioception and touch, pressure, and vibratory sensations in the limbs and body.
Lesions of the hypoglossal nerve in the medulla produce an ipsilateral paralysis of half the tongue with atrophy. The tongue deviates toward the side of the lesion upon protrusion.
Figure IV-5-14. Medial Medullary Syndrome
Medial lemniscus Fibers ofXII
Contralateral spastichemiparesis of body
Contralateral loss ofposition and vibration sense on the body
Tongue deviates to lesion side
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