Bilateral medial medullary infarction

Excerpt

A 72-year-old woman with a history of diabetes, hypertension and prior pontine stroke presented several hours after a fall with weakness and slurred speech. On examination, she had marked tetraparesis, downbeat nystagmus, brisk reflexes, bilateral upgoing toes, but no sensory deficit. Initial CT of head and spine were unremarkable. MRI of the brain (Fig. 1) showed restricted diffusion in both pyramids and medial medullary regions compatible with acute infarction, thus affecting bilateral corticospinal tracts but sparing ascending sensory pathways. A TOF-MRA of anterior and posterior cerebral circulation was obtained at the time of presentation and was normal. Cardiac Holter monitoring and transthoracic echocardiogram was normal. We therefore assumed a microvascular etiology for this patient’s clinical presentation.

…