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A difficult case
A tonsillomedullary stroke causing supranuclear lingual paresis
  1. Thiago Cardoso Vale1,
  2. Rodrigo Alencar e Silva2,
  3. Alysson da Silva Leite2,
  4. Antônio Lúcio Teixeira3,
  5. Clotilde Balucani4
  1. 1Department of Internal Medicine, Federal University of Juiz de Fora (UFJF), Juiz de Fora, Minas Gerais, Brazil
  2. 2Neurology Division, University Hospital, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
  3. 3Laboratório Interdisciplinar de Investigação Médica, Federal University of Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
  4. 4Department of Neurology, SUNY Downstate Medical Center, Brooklyn, New York, USA
  1. Correspondence to Dr Thiago Cardoso Vale, Serviço de Neurologia, Terceiro Andar—Hospital das Clínicas, Universidade Federal de Minas Gerais, Avenida Alfredo Balena 110, Belo Horizonte, Minas Gerais CEP 30130-100, Brazil; thiagocardosovale{at}hotmail.com

https://doi.org/10.1136/practneurol-2013-000713

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    Introduction

    The anatomy of the cortico-hypoglossal projections and the clinical effect of lesions on them are not clear-cut. Lesions close to the midline of the ventral pons typically impair only the contralateral cortico-hypoglossal projections, while lesions extending to the lateral part of the basal pons, or dorsolateral and mediolateral medulla, affect the ipsilateral projections.1 ,2 This suggests that these fibres decussate close to the pontomedullary junction. However, Chang and Cho3 reported a case of contralateral supranuclear glossoplegia due to an ischaemic lesion on the ventromedial part of the rostral medulla, suggesting the fibres cross caudal to the pontomedullary junction.

    We report a case of ischaemic stroke involving the tonsillomedullary segment of the right posterior inferior cerebellar artery that affected …

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    Footnotes

    • Contributors All authors have contributed equally to the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content and administrative, technical and material support.

    • Competing interests None.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed. This article was reviewed by Tom Hughes, Cardiff, UK.

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