Rinsho Shinkeigaku (Clinical Neurology)

Case Report

A case of bilateral medial medullary and left tegmentum of pontine infarction in whom DSA-MR fusion imaging identified infarct-relevant arteries

Mikito Saito, M.D.1j, Hiroyuki Kawano, M.D., Ph.D.1j, Tatsuo Amano, M.D.1j, Haruko Okano, M.D., Ph.D.2j, Toshihiko Iwamoto, R.T.3j and Teruyuki Hirano, M.D., Ph.D.1j

1) Department of Stroke and Cerebrovascular Medicine, Kyorin University Faculty of Medicine
2) Department of Neurology, Kyorin University Faculty of Medicine
3) Department of Radiology, Kyorin University Hospital

We herein reported a patient with acute ischemic stroke in the bilateral medial medullary and the left tegmentum of the pons who presented with various neurological symptoms. Fusing digital subtraction angiography (DSA) and MRI (DSA-MR fusion imaging) could reveal the infarct-relevant arteries. A 41-year-old male presented with headache, bilateral armfs dysesthesia, quadriplegia, left Hornerfs syndrome, upbeat nystagmus, internuclear ophthalmoplegia and left peripheral facial paralysis. Diffusion weighted MRI (DWI) revealed the high intensity lesion in the bilateral medial medullary and the left tegmentum of the pons. MRA showed right vertebral artery (VA) occlusion. A high intensity on T1 weighted imaging was shown on the right VA vessel wall. DSA-MR fusion imaging revealed the anterior spinal artery (ASA) occlusion proximal to the infarction. The stenosis was located at the origin of the right VA perforating branch distributing into the infarct lesion. The steno-occlusive lesion of ASA and VA perforating branch due to VA dissection resulted in infarction in the pontomedullary junction and caused various neurological symptoms. DSA-MR fusion imaging would prove the radiological anatomy of infarct-relevant arteries and clarify the etiology of ischemic stroke.
Full Text of this Article in Japanese PDF (5377K)

(CLINICA NEUROL, 60: 434|440, 2020)
key words: vertebral artery dissection, medial medullary infarction, DSA-MR fusion imaging, internuclear ophthalmoplegia

(Received: 26-Oct-19)