Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of bilateral medial medullary infarction caused by unilateral vertebral artery dissection

Takayoshi Akimoto, M.D.1), Makoto Hara, M.D., Ph.D.1), Mari Saito, M.D.1), Keiko Takahashi, M.D.1) and Satoshi Kamei, M.D., Ph.D.1)

1)Division of Neurology, Department of Medicine, Nihon University School of Medicine

A 34-year-old man developed right neck pain. Several hours later, he felt numbness of his extremities and presented at our hospital. He developed right hemiparesis and hypoesthesia of the right extremities. A few hours later, upbeat nystagmus and dysarthria appeared along with a sensory disturbance that spread to all extremities, and right hemiparesis progressed to tetraplegia. Brain MR diffusion-weighted images revealed a high-intensity lesion in the bilateral medial medulla oblongata and we diagnosed this bilateral medial medullary infarction. Three dimentional CT angiography revealed dissection of the right VA. We administered intravenous argatroban, edaravone, glycerin and oral clopidogrel. He was assessed as having modified Rankin scale 4 and was transferred to another hospital for rehabilitation on day 30. When the medial medulla oblongata is supplied by the unilateral VA, a unilateral VA dissection can cause bilateral medial medullary infarction.
Full Text of this Article in Japanese PDF (498K)

(CLINICA NEUROL, 55: 748|752, 2015)
key words: neck pain, bilateral medial medullary infarction, heart appearance, Three dimentional CT angiography, pearl and string sign

(Received: 15-Apr-15)