Bilateral medial medullary infarction

Case contributed by Dr Varun Babu


Quadriparesis with dysarthria.

Patient Data

Age: 65
Gender: Male

Nonspecific periventricular hypoattenuation seen in bilateral centrum semiovale likely chronic small vessel ischemic changes. 

Since no definite acute focus was identified, DWI MRI was recommended. 

Heart shaped diffusion restriction is seen involving bilateral medial medulla. Another acute focus seen in right periventricular region. 

Nonspecific periventricular arteriosclerotic leukoencephalopathy. Old right pontine infarction. 

Case Discussion

Classic heart-shaped bilateral medial medullary stroke identified well in the MRI DWI imaging. Initially the right corona radiata infarct was only identified, but the clinical presentation of this patient correlates with the medullary infarction. 

This is an area which is quite easily overseen by radiologists due to its caudal location and where artefacts are high, but with the right clinical presentation and early radiological diagnosis, we might be able to salvage irreversible tissue loss. 

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