NEUROIMAGE Year : 2022  |  Volume : 70  |  Issue : 5  |  Page : 2285

Intestinal Pseudo-Obstruction Caused by Bilateral Medial Medullary Infarction

Cheng Xia
Department of Neurology, General Hospital of Northern Theater Command, Shenyang, China

Date of Submission19-May-2022Date of Decision17-Jun-2022Date of Acceptance18-Jun-2022Date of Web Publication21-Oct-2022

Correspondence Address:
Cheng Xia
Department of Neurology, General Hospital of Northern Theater Command, Shenyang
China

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0028-3886.359226

How to cite this article:
Xia C. Intestinal Pseudo-Obstruction Caused by Bilateral Medial Medullary Infarction. Neurol India 2022;70:2285

A 39-year-old man presented to the emergency department for dizziness, slurred speech, right limb weakness, and numbness for 10 h. Head computed tomography (CT) without contrast did not demonstrate an intracranial hemorrhage or other acute intracranial processes. Head and neck CT angiography (CTA) revealed occlusion of the right vertebral artery and segmental stenosis in the left vertebral artery. Half an hour after radiological examination, his neurological deficits deteriorated. Examination found blood pressure of 180/131 mmHg, whole belly bowel sounds weakened, somnolence, bilateral bulbar palsy, quadriplegia, and bilateral extensor plantar response. The diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging (MRI) demonstrated acute infarcts of the bilateral medial medulla oblongata [Figure 1]a. The abdominal CT and X-ray showed intestinal pseudo-obstruction without fecal impaction [Figure 1]b and [Figure 1]c. Admission laboratory studies were pertinent for 138 mmol/L Na and 4.0 mmol/L K. After gastrointestinal decompression, rectal tube decompression, coloclyster, IV neostigmine, and oral simethicone therapy for about 4 weeks, intestinal pseudo-obstruction improved gradually, when he was alert, however, dysarthria and dysphagia remained while the upper and lower extremity strengths improved to Medical Research Council (MRC) right 2 and left 3-4. The main cause in patients with brain lesions is known to be an extrinsic autonomic nervous system, i.e., parasympathetic pathways abnormality. There were previous reports with findings of intestinal obstructions similar to those of this case caused by brainstem lesions.[1],[2],[4] Disorders of the brain stem, such as stroke, affecting gastrointestinal tract function are manifested primarily as abnormalities in motor (rather than sensory or secretory) functions, though intestine pseudo-obstruction occurs rarely.[3]

Figure 1: DWI showed acute bilateral medial medullary infarction (a). Abdominal CT showed gas with niveau (b). Abdominal X-ray disclosed intestinal gas (c)

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