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Case Reports
. 2022 Sep 21;8(3):159-162.
doi: 10.4103/bc.bc_39_22. eCollection 2022 Jul-Sep.

Isolated axial lateropulsion caused by an acute lateral medullary infarction involving the dorsal spinocerebellar tract: A case report

Marco Sparaco  1 , Maria Carmela Addonizio  1 , Giancarlo Apice  1 , Giuseppina Cafasso  1 , Amedeo D'Alessio  1 , Gabriella Di Iasi  1 , Carmine Franco Muccio  2
Affiliations
Case Reports

Isolated axial lateropulsion caused by an acute lateral medullary infarction involving the dorsal spinocerebellar tract: A case report

Marco Sparaco et al. Brain Circ. .

Abstract

Lateral medullary syndrome encompasses a broad spectrum of symptoms and signs depending on the bulbar localization of the lesion. Body lateropulsion (BL) can occur without vestibular and cerebellar symptoms, as a unique manifestation of a lateral medullary infarction. However, it is relatively rare and challenging to diagnose. We report a case of a 72-year-old woman who presented with a tendency to fall to the right. She denied having vertigo, cerebellar signs, sensory loss, or motor weakness. No signs of vestibular dysfunction were found on the ENT examination. Neurological evaluation was unremarkable, except for mild ataxia of the right limbs along with BL to the right side when standing and walking. Brain magnetic resonance (MR) imaging showed an acute small infarct in the right lateral aspect of the medulla extending from the rostral to the caudal level. MR angiography found no stenosis or vascular occlusions. We believe that ipsilateral axial lateropulsion shown by our patient may be related to a selective ischemic lesion of the dorsal spinocerebellar tract in its medullary course. A lateral medullary infarction should be seriously considered in patients who present with isolated BL without further signs of bulbar involvement.

Keywords: Isolated body lateropulsion; medulla oblongata; posterior spinocerebellar tract.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
A diagram (a) indicates the location of the main anatomical structures and of the DSCT (red arrow) in the medulla oblongata. Diffusion-weighted magnetic resonance axial (b) and coronal (c) images show a lesion (white arrow) consistent with an acute infarction in the right lateral aspect of the medulla. MRA found no stenosis or vascular occlusions (d). DSCT: Dorsal spinocerebellar tract, MRA: Magnetic resonance angiography. 1: Pyramid, 2: Inferior olivary nucleus, 3: Medial lemniscus, 4: Anterior spinocerebellar tract, 5: DSCT, 6: Nucleus ambiguous, 7: Inferior cerebellar peduncle, 8: Spinal nucleus of trigeminal nerve, 9: Hypoglossal nucleus, 10; Dorsal motor nucleus of vagus, 11: Solitary nucleus, 12: Vestibular nucleus. RVA = Right vertebral artery, LVA = Left vertebral artery
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