Austin J Clin Neurol 2015;2(4): 1036.
Kumari B, Mehta S* and Lal V
Department of Neurology, Post Graduate Institute of Medical Education and Research, India
*Corresponding author: Sahil Mehta, Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, 103, GH-59, Sector-20,Panchkula, Haryana-134116, India
Received: January 08, 2015; Accepted: March 05, 2015; Published: April 02, 2015
A 50 years old male known diabetic and hypertensive presented to the emergency with sudden onset quadriparesis and respiratory failure with no loss of consciousness. Examination also showed bilateral horizontal gaze evoked nystagmus and tongue weakness. MRI brain revealed bilateral medial medullary infarction giving the appearance of characteristic “heart sign” on axial diffusion and FLAIR images (Figure 1A,B,C). MR angiography showed extensive atherosclerotic disease in the vertebrobasilar system. Bilateral medial medullary infarcts are very rare accounting for < 1% of vertebrobasilar strokes [1,2]. The characteristic heart appearance is well documented in the literature [1,2].
Figure 1: MRI Brain axial images demonstrating the characteristic “heart sign” on DWI (1A), ADC (1B) and FLAIR (1C).
- Maeda M, Shimono T, Tsukahara H, Maier SE, Takeda K. Acute bilateral medial medullary infarction: a unique ‘heart appearance’ sign by diffusion-weighted imaging. Eur Neurol. 2004; 51: 236-237.
- Krishnan M, Rajan P, Kesavdas C, Iyer RS. The ‘heart appearance’ sign in MRI in bilateral medial medullary infarction. Postgrad Med J. 2011; 87: 156-157.