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November 2005

The Trouble With Eponyms—Reply

Author Affiliations

Copyright 2005 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2005

Arch Neurol. 2005;62(11):1785-1786. doi:10.1001/archneur.62.11.1785

In reply

We appreciate Dr Schutta for his interest and helpful comments regarding our article. We agree with Dr Schutta that the diagnosis of Babinski-Nageotte syndrome is inappropriate in our patient with hemiparesis ipsilateral to the brain stem lesion because in this syndrome the hemiparesis is contralateral to the medullary signs. Here, we show magnetic resonance images of our patient at the upper segments of the spinal cord (Figure). Interestingly, the magnetic resonance images show that the lesion is in the lowermost caudal end of the medulla oblongata, not in the spinal cord. As noted by Dr Schutta, Opalski believed that the lesions in his patients were confined to the spinal cord, even when the edema surrounding the infarct was slightly extended into the medulla oblongata. Therefore, it also seems unlikely that the diagnosis of classic or atypical Opalski syndrome is appropriate in our patient if Opalski syndrome is taken to implicitly mean an upper-level spinal cord syndrome. We should therefore describe correctly the clinical condition of our patient as “hemimedullary infarcts with ipsilateral hemiparesis.” We agree completely on the need to avoid describing only certain clinical conditions for the sake of convenience at the expense of accuracy.

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