Acute bilateral medial medullary infarction

Case contributed by Dr Mohammad A. ElBeialy


Adult diabetic and hypertensive patient with sudden onset of quadriparesis and bulbar palsy.

Patient Data

Age: 50 years
Gender: Male
  • The anterior medulla shows a heart or V-shaped lesion of restricted diffusion with high DWI and low ADC signal as well as mild high T2 / FLAIR signal intensity.
  • Multiple minute foci of abnormal signal intensity are noted in both basal ganglia and both centrum semiovale as well as the right cerebellar hemisphere, being of low T1 and high T2 and variable FLAIR signals, likely ischemic.
  •  An ill-defined patchy area of encephalomalcia is noted in the left corona radiata region being of CSF signal (low T1, high T2, and low FLAIR) with exvacuuo-dilatation of the body of the left lateral ventricle and surrounding bright FLAIR signal denoting gliosis.
  • No mass lesions.
  • Normal sellar region.
  • Mild dilatation of ventricular system and prominent cortical sulci.

Case Discussion

Acute bilateral medial medullary infarction; most likley along the territorial supply of anterior spinal artery with the typical heart appearance sign. Atrophic brain changes with bilateral cerebral demyelinating foci; chronic small vessel disease as well as left corona radiata encephalomalacia.

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