血管医学および外科ジャーナル

概要

Favorable Primary Outcome of Bilateral Medial Medullary Infarction: A Case Report

Rabiaa Douma, Bissen Douma, Ben Halima Manel, Mama Nadia , Jemni Hela, Ben Amor Sana

Bilateral Medial Medullary Infarction (MMI) is a rare stroke subtype. Quadriplegia, sensory disturbance, hypoglossal palsy and bulbar paralysis are the most common symptoms but clinical diagnosis without neuroimaging is very difficult.

We report a patient, with a past medical history of diabetes and hypertension, who presented to the emergency with sudden left hemiparesis. After 24 hours, he presented a motor weakness of the right side. Initial brain scan objected only old ischemic lesions. Brain MRI was requested showed characteristic “heart appearance” sign at Diffusion Weighted Imaging (DWI), confirmed bilateral medial medullary stroke. The differential diagnosis such as spinal infraction or Guillan baree syndrome was eliminated by spine MRI and lumbar function.

The main aetiologyof MMI is vertebral artery atherosclerosis and thrombosis affecting the anteromedial and anterolateral territories of medulla. Better understanding of this syndrome will help clinicians recognize bilateral MMI and discuss early therapeutic interventions.