Medullary syndromes

Avellis syndrome

Lesion of nucleus ambiguous and pyramidal tract.

Most often caused by vertebral artery occlusion.

  • Paralysis of the soft palate and vocal cords ipsilaterally
  • Loss of pain sensation and temperature sense contralaterally
  • Horner syndrome and/or involvement of glossopharyngeal and accessory nuclei may coexist

Babinski–Nageotte syndrome

Rare syndrome usually caused by occlusion of intracranial segment of vertebral artery or PICA resulting in damage to medullobulbar transitional area.

  • Ipsilateral cerebellar ataxia
  • Sensory deficits of the face
  • Horner’s syndrome
  • Contralateral hemiplegia
  • Contralateral loss of pain and temperature sensation

Cestan-Chenais syndrome

Caused by multiple lesions in the pyramid, sensory tracts, inferior cerebellar peduncle, nucleus ambiguus, and pupillary center.

  • Ipsilateral ataxia
  • Ipsilateral paralysis of the soft palate and vocal cords
  • Ipsilateral Horner’s syndrome
  • Contralateral hemiplegia
  • Contalateral loss of pain and temperature sensation

Hemimedullary syndrome (Reinhold syndrome)

Caused by occlusion of the vertebral artery proximal to the PICA and its anterior spinal artery branches.

  • Symptoms and signs of lateral medullary syndrome
  • Symptoms and signs of medial medullary syndrome

Jackson-MacKenzie syndrome

May be caused by vertebral artery infarction affecting vagus, accessory and hypoglossal nerve nuclei.

  • Ipsilateral paralysis of soft palate, pharynx, larynx, sternocleidomastoid and trapezius muscles and hemiatrophy of tongue

Medial Medullary syndrome (Dejerine syndrome)

Lesion in the medial medulla.

May be caused by infarct in the territories of the penetrating branches from the basilar or anterior spinal arteries

  • Contralateral weakness of arm and leg
  • Contralateral hemisensory loss of vibration and proprioception
  • Ipsilateral LMN type weakness of the tongue

Lateral Medullary syndrome (Wallenberg syndrome)

Lesion in the lateral medulla.

May be caused by infarct in the territories of the distal, superior or lateral medullary branches of the vertebral artery or the posterior inferior cerebellar artery.

  • Ipsilateral sensory deficit of pain and temperature modalities in the face
  • Contralateral hemisensory loss of pain and temperature modalities
  • Ipsilateral facial pain
  • Ipsilateral ataxia in arm and leg
  • Ipsilateral gait ataxia
  • Nystagmus
  • Nausea/vomiting
  • Hiccups
  • Vertigo
  • Hoarseness
  • Dysphagia
  • Dysarthria
  • Horner syndrome
  • Diplopia and blurred vision
  • Headache

The onset of lateral medullary infarction is sudden in only ~40% of patients, more often it progresses gradually over 24-48h.


About 25% of patients report preceeding TIAs which may have lateral medullary components.