Presentation
Sudden onset of right-sided body weakness with progressive left-sided weakness.
Patient Data
Age: 70 years
Gender: Male
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MRI brain shows hyperintense signal at the ventral, middle, and dorsal part of bilateral median medulla on T2/FLAIR, hypointense signal on T1W at these regions. There is restricted diffusion on DWI/ADC mapping at this region.
MRA brain shows dominant vertebral artery. Loss of normal flow at the distal part of V3 and V4 segment of the right vertebral artery.
Case Discussion
Learning points:
- recognizing the imaging patterns of the medial medullary infarct is crucial
- ventral part contains the pyramidal tract where it is responsible for motor function
- middle part contains the medial lemniscus that important for sensory function
- dorsal part of the medulla contains the medial longitudinal fasciculus where the involvement of this part will cause vertigo/dizziness and ocular motor abnormalities
- some studies reported false-negative MRI in the first 24 hours of examination, especially for brainstem infarcts. High clinical suspicion would help not to miss the diagnosis