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March 07, 2023; 100 (10) Resident & Fellow Section

Teaching NeuroImage: Reinhold Hemimedullary Syndrome

View ORCID ProfilePraveen Kesav, View ORCID ProfileSyed Irteza Hussain, View ORCID ProfileSeby John, Zafar Sajjad, Anu Jacob
First published December 2, 2022, DOI: https://doi.org/10.1212/WNL.0000000000201686
Praveen Kesav
From the Departments of Neurology (P.K., A.J.), Neurology and Neurointerventional Surgery (S.I.H., S.J.), Neurological Institute, and Department of Neuroradiology (Z.S.), Imaging Sciences and Interventional Radiology Institute, Cleveland Clinic Abu Dhabi, UAE.
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  • ORCID record for Praveen Kesav
Syed Irteza Hussain
From the Departments of Neurology (P.K., A.J.), Neurology and Neurointerventional Surgery (S.I.H., S.J.), Neurological Institute, and Department of Neuroradiology (Z.S.), Imaging Sciences and Interventional Radiology Institute, Cleveland Clinic Abu Dhabi, UAE.
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Seby John
From the Departments of Neurology (P.K., A.J.), Neurology and Neurointerventional Surgery (S.I.H., S.J.), Neurological Institute, and Department of Neuroradiology (Z.S.), Imaging Sciences and Interventional Radiology Institute, Cleveland Clinic Abu Dhabi, UAE.
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Zafar Sajjad
From the Departments of Neurology (P.K., A.J.), Neurology and Neurointerventional Surgery (S.I.H., S.J.), Neurological Institute, and Department of Neuroradiology (Z.S.), Imaging Sciences and Interventional Radiology Institute, Cleveland Clinic Abu Dhabi, UAE.
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Anu Jacob
From the Departments of Neurology (P.K., A.J.), Neurology and Neurointerventional Surgery (S.I.H., S.J.), Neurological Institute, and Department of Neuroradiology (Z.S.), Imaging Sciences and Interventional Radiology Institute, Cleveland Clinic Abu Dhabi, UAE.
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Teaching NeuroImage: Reinhold Hemimedullary Syndrome
Praveen Kesav, Syed Irteza Hussain, Seby John, Zafar Sajjad, Anu Jacob
Neurology Mar 2023, 100 (10) 490-491; DOI: 10.1212/WNL.0000000000201686

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A 32-year-old man without vascular risk factors presented with acute onset vertigo, swallowing dysfunction, and right-sided weakness. Physical examination revealed the following signs on the left side: Horner syndrome; lower motor neuron 9th, 10th, and 12th cranial nerve palsies; cerebellar limb ataxia; loss of pain and temperature on the face; and loss of fine touch and proprioception on the face, trunk, and limbs. On the right side, he had hemiplegia with loss of pain and temperature on the trunk and limbs. Brain MRI revealed acute infarct involving the left half of the medulla (Figure, A and B). CT angiogram of the head and neck vessels showed occlusion of the left vertebral artery V4 segment (Figure, C, D, and E). A diagnosis of Reinhold complete hemimedullary syndrome was made (Table).1,-,3 The almost similar incomplete hemimedullary syndrome of Babinski-Nageotte lacks ipsilateral hypoglossal nerve palsy.2 Workup for stroke etiology revealed normal glycosylated hemoglobin, lipid profile, and negative hypercoagulable, autoimmune, and vasculitis panels. Echocardiogram was normal with prolonged cardiac telemetry revealing no cardiac arrhythmias. He was maintained on acetylsalicylic acid 100 mg once daily and atorvastatin 40 mg at nighttime for secondary stroke prophylaxis.

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Figure Classical Hemimedullary Syndrome of Reinhold

Noncontrast brain MRI showing hyperintense signal involving the left hemimedulla on diffusion-weighted imaging (A; black arrow) with corresponding hypointensity on apparent diffusion coefficient sequences (B; black arrow), suggestive of acute infarct. Coronal section of CT cerebral angiogram demonstrating nonvisualization of the left vertebral artery V4 segment (C; white arrow) and intact basilar artery flow distally (E; white arrow). Abrupt occlusion of the left vertebral artery V4 segment shown on the three-dimensional shaded surface display volume rendering (SS-VRT) reconstructed images (D; white arrow).

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Table

Description of the Medullary Vascular Syndromes

Study Funding

The authors report no targeted funding.

Disclosure

The authors report no relevant disclosures. Go to Neurology.org/N for full disclosures.

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Table

Footnotes

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Submitted and externally peer reviewed. The handling editor was Whitley Aamodt, MD, MPH.

  • Teaching Slides links.lww.com/WNL/C515

  • Received July 27, 2022.
  • Accepted in final form October 27, 2022.
  • © 2022 American Academy of Neurology

References

  1. 1.↵
    1. Mossuto-Agatiello L,
    2. Kniahynicki C
    . The hemimedullary syndrome: case report and review of the literature. J Neurol. 1990; 237(3):208-212. doi: 10.1007/bf00314596
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Krasnianski M,
    2. Neudecker S,
    3. Schluter A,
    4. Zierz S
    . Babinski-Nageotte’s syndrome and Hemimedullary (Reinhold's) syndrome are clinically and morphologically distinct conditions. J Neurol. 2003; 250(8):938-942. doi: 10.1007/s00415-003-1118-9
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Gan R,
    2. Noronha A
    . The medullary vascular syndromes revisited. J Neurol. 1995; 242(4):195-202. doi: 10.1007/bf00919591
    OpenUrlCrossRefPubMed

Letters: Rapid online correspondence

  • Author Response: Teaching NeuroImage: Reinhold Hemimedullary Syndrome
    • Praveen Kesav, Neurologist, Cleveland Clinic Abu Dhabi
    Submitted April 16, 2023
  • Reader Response: Teaching NeuroImage: Reinhold Hemimedullary Syndrome
    • Yannick Béjot, Neurologist, University Hospital of Dijon, Dijon Stroke Registry, France
    Submitted March 17, 2023
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