Neurogenic Cough Associated with Hyperintensity in Dorsal Medulla: Case Report and Anatomical Discussion

World Neurosurg. 2020 Dec:144:196-198. doi: 10.1016/j.wneu.2020.09.096. Epub 2020 Sep 22.

Abstract

Background: The nucleus tractus solitarius and paratrigeminal nucleus, which are implicated in the processing of airway-derived sensory information, are found in the dorsal medulla. The mechanism and localization of higher-order processing of urge to cough is poorly understood, and much of the existing anatomical localization is limited to animal studies.

Case description: A 44-year-old Caucasian lady underwent elective foramen magnum decompression for symptomatic Chiari I malformation; postoperatively she had resolution of Chiari symptoms but developed an intractable neurogenic cough. She has no significant medical history or premorbid respiratory issues. Postoperative magnetic resonance imaging of her head demonstrated signal change in the left dorsal medulla, corresponding with the nucleus tractus solitarius and paratrigeminal nucleus.

Conclusions: We suggest that this lesion explains her isolated new cough and localizes the pathway for "urge to cough" to this region of the medulla.

Keywords: Case report; Medulla; Neurogenic cough; Nucleus tractus solitarius; Paratrigeminal nucleus; Urge-to-cough; Vagus.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Arnold-Chiari Malformation / diagnostic imaging
  • Arnold-Chiari Malformation / surgery*
  • Cough / diagnostic imaging
  • Cough / etiology*
  • Cough / therapy
  • Decompression, Surgical / methods
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Medulla Oblongata / anatomy & histology
  • Medulla Oblongata / diagnostic imaging*
  • Neurosurgical Procedures / adverse effects
  • Postoperative Complications / diagnostic imaging*
  • Postoperative Complications / therapy*
  • Treatment Outcome