Lateral Medullary Infarction Presenting Contralateral Palatal Paresis

10.29819/ANT.200812.0004

Chien-Ming Chen；Tzu-Ying Huang

Soft palate paresis ； Lateral medullary infarction ； Nucleus ambiguus ； Peri-ambigual reticular formation ； Disconnection dysphagia

Acta Neurologica Taiwanica

17卷4期（2008 / 12 / 01）

239 - 242

英文

Palatopharyngeal paresis has never been reported to be contralateral in the lateral medullary infarction (LMI). A 65-year-old lady with acute dorsolateral infarction in the left medulla presented mild hoarseness, mild dysphagia, mild gait ataxia along with marked hypalgesia and thermoanesthesia on the right limbs. To our surprise, palatal weakness was on the right side, instead of being on the left side as expected in typical Wallenburg syndrome. The palatal paresis was noted during voluntary phonation but turned into normal movement while gag reflex was induced. An involvement of corticobulbar fibers before synapsing into the ipsilateral caudal medulla or a selective involvement of the peri-ambigual reticular formation and/or its post-synaptic connection fiber destined to the contralateral swallowing center presumably underlies such a rare contralateral palatal paresis.