title: Dorsal Medullary Infarction: Distinct Syndrome of Isolated Central Vestibulopathy.
abstract: OBJECTIVE
  The characteristics of infarctions restricted to the dorsal medulla have received little attention. This study aimed to define the distinct clinical features of dorsal medullary infarction.
  
  
  METHODS
  Of the 172 patients with a diagnosis of medullary infarction at Seoul National University Bundang Hospital from 2003 to 2014, 18 patients with isolated dorsal medullary infarction were subjected to analyses of clinical and laboratory findings.
  
  
  RESULTS
  All patients presented acute isolated vestibular syndrome with dizziness/vertigo and imbalance. Almost all patients (17/18, 94%) showed the signs from involvements of the vestibular nuclei, nucleus prepositus hypoglossi, or inferior cerebellar peduncle, which included direction-changing gaze-evoked nystagmus (n=12), negative head-impulse tests (n=8), skew deviation (n=7), central patterns of head-shaking nystagmus (n=6), and spontaneous nystagmus (n=2). Initial magnetic resonance imagings including diffusion-weighted images were negative in 7 patients (39%). Twelve patients (67%) showed a progression and developed additional neurological abnormalities, but the neurological outcomes were favorable.
  
  
  CONCLUSIONS
  The presence of central vestibular signs allows bedside differentiation of isolated vestibular syndrome because of dorsal medullary infarction from acute peripheral vestibular disorders. Because initially false-negative magnetic resonance imagings and subsequent progression are frequent in dorsal medullary infarction, early recognition through scrutinized evaluation is important for proper managements.
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
authors.forename: Sun-Uk
authors.initials: SU
authors.lastname: Lee
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
authors.forename: Seong-Ho
authors.initials: SH
authors.lastname: Park
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
authors.forename: Jeong-Jin
authors.initials: JJ
authors.lastname: Park
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
authors.forename: Hyo Jung
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
authors.forename: Moon-Ku
authors.initials: MK
authors.lastname: Han
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.).
authors.forename: Hee-Joon
authors.initials: HJ
authors.lastname: Bae
authors.affiliation: From the Department of Neurology, Ajou University School of Medicine, Ajou University Hospital, Suwon, Korea (S.-U.L.); Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea (S.-H.P., M.-K.H., H.-J.B., J.-S.K.); Department of Radiology, Samsung Medical Center, Seoul, South Korea (J.-J.P.); and Department of Biomedical Laboratory Science, Kyungdong University, Goseong-Gun, Gangwon-do, Korea (H.J.K.). jisookim@snu.ac.kr.
authors.forename: Ji-Soo
authors.initials: JS
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D020526:Brain Stem Infarctions / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology*; D008875:Middle Aged; D013577:Syndrome; D015837:Vestibular Diseases / Q000175:diagnosis / Q000453:epidemiology; D020338:Vestibular Neuronitis / Q000175:diagnosis* / Q000453:epidemiology*
keywords: dizziness; infarction; vertigo; vestibular nuclei