Acute medullary pyramidal infarction
Vasculopath. Sudden onsest of weakness and vertigo ? stroke
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Extensive periventricular T2 brightening is very abnormal in a patient of this age and is consistent with diffuse small vessel disease. Focus of abnormal T2 brightening in the right medullary pyramid with restricted diffusion (+ve ADC) and an occluded right vertebral artery
This is part of the spectrum of medial medullary syndrome due to occlusion of the anterior spinal artery at the time of vertebral artery occlusion. It is very rare and presents with the classic triad of contralateral hemiplegia sparing the face, disturbance of deep sensation and ipsilateral hypoglossal nerve palsy.
- http://www.turner-white.com/memberfile.php?PubCode=hp_aug08_hemiplegia.pdf http://stroke.ahajournals.org/content/21/6/963.full.pdf