Progressive bilateral medial medullary infarction

Excerpt

A 63-year-old man came to our attention for mild left-sided paresis and dysarthria with acute onset. Emergency CT scan and CT angiography showed no abnormalities and the patient was given intravenous thrombolysis with alteplase at 2 hours from the beginning of the symptoms. The patient, however, worsened into a rapidly progressive tetraparesis without any sensory or cerebellar impairments. An urgent MRI scan showed a tiny isolated alteration, visible only in DWI sequences and limited to both pyramidal tracts in the medulla oblongata (Fig. 1a, b). The patient’s condition kept deteriorating and reached a complete quadriplegia with the need of mechanical ventilation in the following hours. A second MRI scan disclosed an extension of the previous brainstem lesion (Fig. 1c, d).

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