A medullary stroke affects the part of the brain called the medulla. There are two main types of medullary stroke. They have different symptoms but similar treatments.

This article provides an in-depth guide to medullary stroke. It details its symptoms, diagnosis, and management. It will also explore the causes, prevention, and outlook for medullary stroke.

A person in hospital after experiencing a medullary stroke.Share on Pinterest
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A medullary stroke is a stroke within the medulla. During a medullary stroke, the medulla does not receive enough blood.

There are two main forms of medullary stroke:

  • Lateral medullary stroke: This type affects the sides of the medulla. Doctors sometimes call it Wallenberg syndrome.
  • Medial medullary stroke: The type affects the middle section of the medulla. Doctors sometimes call it Dejerine syndrome.

Lateral medullary strokes are more common than medial ones.

Where is the medulla located?

The medulla is a part of the brain stem, which is the organ that connects the brain to the spinal cord. The medulla is located just above the spinal cord.

Lateral and medial medullary strokes typically have different symptoms.

Symptoms of lateral medullary strokes include:

According to a 2022 article, symptoms of a medial medullary stroke can include paralysis of the legs or arms on one side of the body and problems with swallowing.

In some cases, medial medullary strokes can cause a loss of sensation in one side of the body.

A stroke occurs when there is reduced blood flow within the brain.

Medullary strokes are a type of ischemic stroke. Ischemic strokes occur when a blood clot travels into a blood vessel, stopping the blood flow within parts of the brain.

Lateral medullary stroke

Lateral medullary strokes occur as a result of:

  • atherosclerotic disease, which can result in a thromboembolism, or blood clot
  • high blood pressure
  • a cardiac embolism, which can result from:
  • small vessel disease, a condition in which the small vessels in the heart and brain do not work correctly
  • moyamoya disease, a rare disorder that affects the blood vessels, causing a blockage in the carotid artery
  • vertebrobasilar dolichoectasia, a progressive condition that causes the dilation and elongation of the basilar artery

Medial medullary stroke

Medial medullary strokes most commonly occur due to a blockage of one of the following arteries:

  • anterior spinal artery, which is the major blood supply for the spine
  • vertebral artery, which runs through the spinal column in the neck to supply blood to the spine and brain
  • basilar artery, which is the main artery that supplies blood to the brain

Other causes include:

  • A-fib
  • atrial septal defect, a congenital abnormality in which there is a hole in a wall of the heart
  • patent foramen ovale, or a hole in the heart
  • Takayasu arteritis, a rare type of vasculitis causing inflammation of the blood vessels

Risk factors can include:

As a 2021 review explains, treatment for lateral medullary strokes has several main components:

  • Emergency treatment: This may involve resuscitation followed by monitoring in an intensive care unit. Healthcare professionals will look for complications such as respiratory failure and increased pressure within the skull.
  • Restoring blood flow: This may involve taking clot-destroying medications. It may also involve the surgical removal of blood clots.
  • Avoiding a secondary stroke: This longer-term aspect of treatment may involve taking anti-clotting medications. It should also involve treating the underlying cause of the stroke.

The treatment for medial medullary stroke is much the same, according to a 2022 review.

When a medullary stroke occurs, it can cause significant damage to the medulla. As a 2021 article explains, recovering from a medullary stroke involves learning to manage its longer-term effects. This can take many different forms.

For example, strokes can cause long-term difficulties with swallowing. People may notice these difficulties ease after performing specialized exercises. Others may need to alter the types of food they eat in order to make swallowing easier.

Strokes can also cause difficulties with speech and mobility. These will also require long-term, specialized treatment.

According to a study in Frontiers in Neurology, the outlook for a person who has had a medullary stroke is poor.

The authors note that 10.6% of people die within 6.5 years of having a medullary stroke. Within this time period, around 6.1% of people will experience at least one other stroke.

In addition, serious health problems affect around 20.9% of people who leave hospital after a medullary stroke.

There are three main components in lateral medullary stroke diagnosis:

  • evaluating risk factors of strokes to help determine the likelihood of a stroke
  • evaluating neurological symptoms to help determine the type of stroke
  • imaging techniques such as CT scan, magnetic resonance angiography, and computed tomography angiography scans to precisely locate the stroke

Doctors can also use these same methods to diagnose a medial medullary stroke.

According to the Centers for Disease Control and Prevention (CDC), certain lifestyle factors can lower the risk of having a stroke. These include:

Stroke prevention can also involve keeping certain health conditions under control. These include:

  • heart disease
  • high blood pressure
  • diabetes

People with these conditions, and people who have high cholesterol, should also receive a blood cholesterol checkup at least once every 5 years.

A medullary stroke happens when there is reduced blood flow to the medulla. The medulla is a part of the brain stem located just above the spinal cord.

Medullary strokes typically happen when a blood clot causes a blockage of blood flow to the brain.

The outlook for a medullary stroke is poor. However, scientists continue to develop new lines of treatment, and many strokes are preventable.