Medial medullary syndrome
ICD-10 I63.2 · ICD-11 8B26.01

What Is the Treatment of Medial Medullary Syndrome in Acute Ischemic Stroke?

Medial medullary syndrome results from ischemic injury to the medullary brainstem. When it presents as part of an acute ischemic stroke, the time elapsed since symptom onset is a critical factor in treatment eligibility, and clinical assessment must proceed without delay.

Treatment Approach

In selected patients presenting within an appropriate time window from stroke onset, intravenous thrombolytic therapy is the primary intervention. Where blood pressure is elevated beyond specified thresholds, targeted intravenous antihypertensive management is applied first — before thrombolytic therapy is initiated.

Patient selection criteria, precise timing thresholds, the blood pressure management sequence, and the full dosing algorithm are detailed in the complete protocol.

Clinical Goal

The primary measure of treatment success is neurological improvement at 24 hours — defined as either complete neurological recovery or a clinically meaningful improvement on the NIHSS. The protocol specifies how this endpoint guides further management.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1161/STR.0b013e318284056a

  1. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for selected patients who may be treated within 3 hours of onset of ischemic stroke (Class I; Level of Evidence A).
  2. Intravenous rtPA (0.9 mg/kg, maximum dose 90 mg) is recommended for administration to eligible patients who can be treated in the time period of 3 to 4.5 hours after stroke onset (Class I; Level of Evidence B).
  3. Patients who have elevated blood pressure and are otherwise eligible for treatment with intravenous rtPA should have their blood pressure carefully lowered so that their systolic blood pressure is <185 mm Hg and their diastolic blood pressure is <110 mm Hg (Class I; Level of Evidence B) before fibrinolytic therapy is initiated.
  4. In the first trial (Part I), the primary end point was neurological improvement at 24 hours, as indicated by complete neurological recovery or an improvement of 4 points on the NIHSS.
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