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Two or three decades ago we saw a patient who had a lateral medullary infarct characterized in the first few days by wild movements on attempted motion of the ipsilateral arm. It was postulated that this unusual picture might have resulted from involvement of the sensory centers of the caudal medulla. Four similar patients have since been examined, two in the acute phase, and followed. One was studied by MRI scan and one by autopsy.
The five patients were men, age 44 to 74. The clinical picture was consistent. There was less nausea, vomiting (two of the five vomited), vertigo, dysphagia, and dysarthria than with the usual lateral medullary syndrome1 but more ipsilateral arm and to a lesser extent leg ataxia. The bulbar symptoms were not severe and were short lived. Hoarseness was present in four of the five and hiccups that lasted a few days were noted in three. The unilateral ataxia was characterized by wild motion of the proximal ipsilateral arm and in two of the ipsilateral legs, with any voluntary movement. When upward movement of the …
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