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KMID : 0857020100250010117
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Kosin Medical Journal
2010 Volume.25 No. 1 p.117 ~ p.119
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Micturition Disturbance in a Patient With Acute Lateral Medullary Infarction
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Lee Won-Gu
Kim Meyung-Kug
Yoo Bong-Goo
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Abstract
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Although the urinary dysfunction was associated with a pontine lesion in most cases, information about the precise anatomic localization was limited. Furthermore, micturitional disturbance has rarely been reported in patients with lateral medullary infarction. A 74-year-old man developed difficulty in initiation of voiding, swallowing difficulty and dysarthria for 1 day. Neurological examination revealed hypesthesia in the left face and right limbs and trunk, left eye ptosis and anisocoria, and left facial palsy. Diffusion-weighted MRI showed acute infarction in the left lateral medulla. Initial residual bladder volume after voiding was 800 mL. Urodynamic study showed flaccid type of neurogenic bladder. After 2 weeks, his voiding symptom has been nearly recovered with little residual urine (100 mL). Urinary retention can be easily overlooked in many patients with unilateral medullary infarction because of its transience or clinical inattention. This case suggested that urinary retention might be caused by interruption of descending fibers from facilitatory pontine tegmentum micturition centers.
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KEYWORD
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Lateral medullary syndrome, Neurogenic bladder, Cerebral infarction
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