Bilateral medial medullary infarction: Heart appearance

摘要

Sir,A 60-year-old hypertensive male presented with acute onset of slurred speech, weakness of right upper and lower limb followed by weakness of left upper limb and lower limb and difficulty in swallowing of 1-day duration. On examination he had bulbar palsy and quadriparesis. Magnetic resonance imaging (MRI) showed "heart shaped" restricted diffusion [Figure la] with low apparent diffusion coefficient (ADC) values [Figure lb] with T2-wieghted sequence [Figure lc] and FLAIR hyper intensities in the corresponding areas suggesting bilateral medial medullary infarction. MR-angiography [Figure Id] showed signal drop in the right vertebral artery.