PRIMARY MEDULLARY HEMORRHAGE - REPORT OF 4 CASES AND REVIEW OF THE LITERATURE

Background Primary medullary hemorrhage is uncommon. Its clinical prof ile and prognosis are not well known. We report four cases of medullar y hemorrhage and a review of the English and French literature since 1 964 to analyze the clinical presentation and prognosis. Case Descripti ons Of sixteen case reports of medullary hemorrhage reviewed from the literature, sixteen contained sufficient information for review and ar e included in this report. The age distribution of the patients was be tween 13 and 72 years, and 10 of these patients were men. The most fre quent symptoms at onset were vertigo, sensory symptoms, and dysphagia. Presenting signs included palatal weakness, nystagmus, hypoglossal pa lsy, cerebellar ataxia, and limb weakness. The diagnosis was made at a utopsy in 3 patients, at surgery in 3, by computed tomography in 4, an d more recently by magnetic resonance imaging in 6. In nine instances the etiology of hemorrhage was undetermined; a ruptured vascular malfo rmation was the cause in 3 patients, 1 was attributed to the use of an ticoagulants, and hypertension was the suspected cause in the other 3 patients. Mortality rate was 19%; however, survivors generally had non incapacitating sequelaes. Conclusions These findings indicate that pri mary medullary hemorrhage presents with a characteristic syndrome of s udden onset of headache and vertigo with neurological signs that corre spond to various combinations of medial and lateral medullary involvem ent. In those patients who survive, prognosis usually is good.