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Case report: Spiller syndrome initially mimicking vestibular neuritis

Spiller syndrome is a rare subtype of medial medullary infarction (MMI). Herein, we report on a patient with progressing stroke who presented with the initial features of acute peripheral vestibulopathy and MMI (Spiller syndrome), as confirmed by magnetic resonance imaging (MRI). A 42-year-old man e...

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Autores principales: Wang, Huiyuan, Shi, Tianming, Shang, Yafei, Chen, Xinyi, Xu, Jie, Geng, Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9868901/
https://www.ncbi.nlm.nih.gov/pubmed/36698901
http://dx.doi.org/10.3389/fneur.2022.1072220
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author Wang, Huiyuan
Shi, Tianming
Shang, Yafei
Chen, Xinyi
Xu, Jie
Geng, Yu
author_facet Wang, Huiyuan
Shi, Tianming
Shang, Yafei
Chen, Xinyi
Xu, Jie
Geng, Yu
author_sort Wang, Huiyuan
collection PubMed
description Spiller syndrome is a rare subtype of medial medullary infarction (MMI). Herein, we report on a patient with progressing stroke who presented with the initial features of acute peripheral vestibulopathy and MMI (Spiller syndrome), as confirmed by magnetic resonance imaging (MRI). A 42-year-old man experienced acute persistent vertigo with nausea, vomiting, and severe gait instability for 6 h before presenting to the emergency department. He exhibited spontaneous right-beating horizontal-torsional nystagmus that intensified on rightward gaze. The patient fell to the left side during the Romberg test. Cranial computed tomography (CT) performed immediately upon admission did not provide evidence for ischemia or hemorrhage of the brainstem and cerebellum; however, the symptoms underwent exacerbation 4 h after admission, manifesting as left-sided limb weakness and dysarthria, without dysphagia. Furthermore, bedside examination revealed difficulty in extending the tongue to the right, positive left Babinski's sign, and abnormal vibration and position sense in the paralyzed limb. Head impulse test recording revealed a normal gain in the vestibulo-ocular reflex, and numerous consistent covert corrective saccades were captured upon turning the head to the left side. Cranial MRI depicted an acute infarct confined to the right side of the medial medulla, which met the diagnostic criteria for Spiller syndrome. Our study underscores the importance of considering the possibility of a nucleus prepositus hypoglossi lesion even if the signs and symptoms support the diagnosis of peripheral lesions in patients with acute vestibular syndrome exhibiting vascular risk factors.
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spelling pubmed-98689012023-01-24 Case report: Spiller syndrome initially mimicking vestibular neuritis Wang, Huiyuan Shi, Tianming Shang, Yafei Chen, Xinyi Xu, Jie Geng, Yu Front Neurol Neurology Spiller syndrome is a rare subtype of medial medullary infarction (MMI). Herein, we report on a patient with progressing stroke who presented with the initial features of acute peripheral vestibulopathy and MMI (Spiller syndrome), as confirmed by magnetic resonance imaging (MRI). A 42-year-old man experienced acute persistent vertigo with nausea, vomiting, and severe gait instability for 6 h before presenting to the emergency department. He exhibited spontaneous right-beating horizontal-torsional nystagmus that intensified on rightward gaze. The patient fell to the left side during the Romberg test. Cranial computed tomography (CT) performed immediately upon admission did not provide evidence for ischemia or hemorrhage of the brainstem and cerebellum; however, the symptoms underwent exacerbation 4 h after admission, manifesting as left-sided limb weakness and dysarthria, without dysphagia. Furthermore, bedside examination revealed difficulty in extending the tongue to the right, positive left Babinski's sign, and abnormal vibration and position sense in the paralyzed limb. Head impulse test recording revealed a normal gain in the vestibulo-ocular reflex, and numerous consistent covert corrective saccades were captured upon turning the head to the left side. Cranial MRI depicted an acute infarct confined to the right side of the medial medulla, which met the diagnostic criteria for Spiller syndrome. Our study underscores the importance of considering the possibility of a nucleus prepositus hypoglossi lesion even if the signs and symptoms support the diagnosis of peripheral lesions in patients with acute vestibular syndrome exhibiting vascular risk factors. Frontiers Media S.A. 2023-01-09 /pmc/articles/PMC9868901/ /pubmed/36698901 http://dx.doi.org/10.3389/fneur.2022.1072220 Text en Copyright © 2023 Wang, Shi, Shang, Chen, Xu and Geng. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Wang, Huiyuan
Shi, Tianming
Shang, Yafei
Chen, Xinyi
Xu, Jie
Geng, Yu
Case report: Spiller syndrome initially mimicking vestibular neuritis
title Case report: Spiller syndrome initially mimicking vestibular neuritis
title_full Case report: Spiller syndrome initially mimicking vestibular neuritis
title_fullStr Case report: Spiller syndrome initially mimicking vestibular neuritis
title_full_unstemmed Case report: Spiller syndrome initially mimicking vestibular neuritis
title_short Case report: Spiller syndrome initially mimicking vestibular neuritis
title_sort case report: spiller syndrome initially mimicking vestibular neuritis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9868901/
https://www.ncbi.nlm.nih.gov/pubmed/36698901
http://dx.doi.org/10.3389/fneur.2022.1072220
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