“Heart Shaped Sign” in Bilateral Medial Medullary Infarction
Keywords:
Bilateral medial medullary infarction (MMI).Abstract
We present the report of a 70-year-old male patient who was admitted due to the problem of alteration of consciousness. Examinations revealed bilateral ptosis, vertical nystagmus, limitation of his movement of extraocular muscles on horizontal and vertical direction and quadriparesis. He was diagnosed with acute bilateral medial medullary infarction (MMI). The Magnetic resonance imaging (MRI) of brain showed ‘‘heart-shaped’’ hyposignal intensity area on T1-weighted, hypersignal intensity on T2-weighted, fluid-attenuated inversion recovery (FLAIR) and restricted diffusion on diffusion-weighted image (DWI), low signal in apparent diffusion coefficient image (ADC) at the bilateral upper part of medulla oblongata extending to the pontomedullary junction. Contrast-enhanced magnetic resonance angiography (contrast-enhanced MRA) of brain showed irregular narrowing of the left vertebral artery than the right side and atherosclerotic change of both middle cerebral arteries, both posterior cerebral arteries and basilar artery. He was treated with aspirin, atorvastatin and antibiotic for a problem of aspiration pneumonia. He was on physiotherapy and rehabilitation, required tracheostomy and percutaneous gastrostomy tube placement, with no paralysis resolution.
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