“Heart Appearance” Infarction of the Pons: A Case Report

“Heart appearance” on magnetic resonance imaging (MRI) is a unique presentation of bilateral medial medullary infarction. In contrast, “heart appearance” infarction of the pons has rarely been featured in the medical literature. In this paper, we present a case of “heart appearance” infarction of the pons with its MRI and magnetic resonance angiography (MRA) findings. The patient was an 87-year-old male who manifested with weakness in the four extremities. Later, bulbar palsy and tetraplegia became apparent, and he eventually was trapped in locked-in syndrome. Brain MRI disclosed a “heart appearance” lesion in the pons, which was high on diffusion-weighted image MRI and low on apparent diffusion coefficient map MRI. Brain MRA demonstrated that the basilar artery remained intact. A diagnosis of fresh, bilateral pontine infarction with a “heart appearance” was made. After the treatment he was transferred to another hospital for long-term care. This case suggests that bilateral ischemic involvement of the pons is possible even in the context of an intact basilar artery.

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Unusual neurological manifestations of bilateral medial medullary infarction: A case report

Open Medicine ◽

10.1515/med-2021-0382 ◽

2022 ◽

Vol 17 (1) ◽

pp. 119-123

Author(s):

Ruizhi Zheng ◽

Ting Zhang ◽

Xianzhu Zeng ◽

Miao Yu ◽

Zhao Jin ◽

...

Keyword(s):

Early Stage ◽

Brain Mri ◽

Resonance Imaging ◽

Mri Findings ◽

Rare Type ◽

Acute Ischemic Stroke Patient ◽

Medial Medullary Infarction ◽

Functional Consequences ◽

Magnetic Resonance Imaging Mri ◽

Medullary Infarction

Abstract Bilateral medial medullary infarction (BMMI) is an extremely rare type of cerebrovascular accident often resulting in poor functional consequences. “Heart appearance” on diffusion-weighted imaging (DWI) of magnetic resonance imaging (MRI) is the unique presentation of BMMI. In this article, we present an acute ischemic stroke patient whose brain MRI showed the atypical “heart appearance” sign, manifested unusual bilateral central facial paralysis concurrently. For an early diagnosis of BMMI, it is essential to recognize the characteristic clinical and MRI findings of this rare type of stroke. Abnormal small dot or linear DWI signal at the midline of the brainstem should not be ignored at the early stage of stroke.

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PHACE Syndrome: A Rare Case

Journal of Pediatric Genetics ◽

10.1055/s-0039-1694705 ◽

2019 ◽

Vol 09 (01) ◽

pp. 027-031

Author(s):

Ceylan Altintas Taslicay ◽

Elmire Dervisoglu ◽

Ercument Ciftci ◽

Funda Corapcioglu ◽

Yonca Anik

Keyword(s):

Magnetic Resonance ◽

Brain Mri ◽

Vascular Disorder ◽

Resonance Imaging ◽

Term Outcome ◽

Long Term Outcome ◽

Phace Syndrome ◽

Posterior Fossa Malformations ◽

Magnetic Resonance Imaging Mri

AbstractPHACE syndrome (OMIM 606519) is a rare neurocutaneous vascular disorder, characterized by posterior fossa malformations, large cervicofacial infantile hemangiomas, arterial anomalies, aortic coarctation, cardiac abnormalities, and eye abnormalities. The long-term outcome of PHACE syndrome patients is unclear; however, it seems that they are at risk for childhood stroke. The radiologist has an important role on diagnosis of PHACE syndrome and in the assessment of potential complications. Investigation of infants with segmental craniofacial hemangiomas should include cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the cerebral and cervical arteries. Brain MRI and MRA findings of a 5-year-old female patient with PHACE syndrome are presented.

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A patient with bilateral medial medullary infarction: Clinical and magnetic resonance imaging findings

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101126 ◽

2021 ◽

Vol 25 ◽

pp. 101126

Author(s):

Rikitaro Sako ◽

Satoshi Yamamoto ◽

Kotaro Takeda ◽

Masahiro Wakatabi ◽

Minoru Daira ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Imaging Findings ◽

Resonance Imaging ◽

Medial Medullary Infarction ◽

Medullary Infarction

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Pediatric Reversible Cerebral Vasoconstriction Syndrome: Two Unique Cases with a Review of all Reported Children

Journal of Pediatric Neurology ◽

10.1055/s-0041-1722959 ◽

2021 ◽

Author(s):

Neelu Desai ◽

Rahul Badheka ◽

Nitin Shah ◽

Vrajesh Udani

Keyword(s):

Magnetic Resonance ◽

Cerebral Arteries ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Reversible Cerebral Vasoconstriction Syndrome ◽

Neurological Deficits ◽

Cerebral Vasoconstriction ◽

Magnetic Resonance Imaging Mri ◽

Reversible Encephalopathy ◽

Mr Angiogram

AbstractReversible cerebral vasoconstriction syndrome (RCVS) has been well described in adults, but pediatric cases are yet under recognized. We describe two children with RCVS and review similar already published pediatric cases. The first patient was a 10-year-old girl who presented with severe headaches and seizures 3 days after blood transfusion. Brain magnetic resonance imaging (MRI) showed changes compatible with posterior reversible encephalopathy syndrome and subarachnoid hemorrhage. Magnetic resonance angiogram showed diffuse vasoconstriction of multiple cerebral arteries. The second patient was a 9-year-old boy who presented with severe thunderclap headaches. Brain MRI showed isolated intraventricular hemorrhage. Computed tomography/MR angiogram and digital subtraction angiogram were normal. A week later, he developed focal neurological deficits. Repeated MR angiogram showed diffuse vasospasm of multiple intracranial arteries. Both children recovered completely. A clinico-radiological review of previously reported childhood RCVS is provided.

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Isolated Wrist Drop Presenting as Acute Stroke: Rare Case Report with Review of Literature

Journal of Neurosciences in Rural Practice ◽

10.4103/jnrp.jnrp_115_18 ◽

2018 ◽

Vol 09 (04) ◽

pp. 647-649

Author(s):

Khushbu Goel ◽

Saraj Kumar Singh ◽

Himanshu Agarwal ◽

Joy Dev Mukherji ◽

Mukesh Kumar

Keyword(s):

Magnetic Resonance ◽

Acute Stroke ◽

Brain Mri ◽

Intravenous Thrombolysis ◽

Acute Onset ◽

Cerebral Stroke ◽

Rare Presentation ◽

Rare Case Report ◽

Magnetic Resonance Imaging Mri ◽

Wrist Drop

ABSTRACTIsolated wrist drop is very unusual clinical presentation due to cerebral stroke. It is highly confused with peripheral neuropathy. However, timely detection of acute stroke as one of the causes of wrist drop is necessary as it changes the line of treatment and prognosis significantly. Here we are presenting a 62 year-old diabetic and hypertensive male patient who came with acute onset weakness of right hand. Initial Magnetic resonance imaging (MRI) of the brain showed hyperacute infarct in the splenium of corpus callosum. Magnetic resonance angiography (MRA) was normal. Repeat brain MRI on next day showed acute infarct at hand area of motor strip in posterior frontal region. The patient underwent intravenous thrombolysis and thereafter improved significantly. Isolated hand palsy is a rare presentation of stroke, often mistaken for peripheral lesion.

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Can we evaluate cranial aneurysms on conventional brain magnetic resonance imaging?

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.165425 ◽

2016 ◽

Vol 7 (01) ◽

pp. 83-86 ◽

Cited By ~ 1

Author(s):

Emine Caliskan ◽

Yeliz Pekcevik ◽

Adnan Kaya

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Characteristic Curve ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Kappa Statistics ◽

Resonance Imaging ◽

Vascular Structures ◽

Magnetic Resonance Imaging Mri ◽

Age Range

ABSTRACT Purpose: To evaluate the contribution of conventional brain magnetic resonance imaging (MRI) for the determination of intracranial aneurysms. Materials and Methods: Brain MRI and computed tomography angiography (CTA) of 45 patients (29 women and 16 men; age range, 32–80 years) with aneurysm were analyzed. A comparison was made between brain MRI and CTA based on size and presence of aneurysm. The comparisons between MRI and CTA were investigated through Bland-Altman graphics, receiver operating characteristic curve, and Kappa statistics. Results: Fifty-seven aneurysms were evaluated. Forty-five percent of 57 aneurysms on CTA were detected on conventional brain MRI. A significant correlation was found between CTA and brain MRI in the diagnosis of aneurysm (P < 0.05). In an analysis of the size measurement, a significant correlation was observed between CTA and brain MRI. Seventy-seven percent of aneurysms <4 mm was not detected and the efficiency of MRI in the detection of aneurysms <4 mm was found to be low. Conclusion: Aneurysms can also be appreciated on conventional brain MRI, and vascular structures should be reviewed carefully while analyzing brain MRI.

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A Novel SUCLA2 Mutation Presenting as a Complex Childhood Movement Disorder

Journal of Child Neurology ◽

10.1177/0883073816666221 ◽

2016 ◽

Vol 32 (2) ◽

pp. 246-250 ◽

Cited By ~ 3

Author(s):

Caterina Garone ◽

Juliana Gurgel-Giannetti ◽

Simone Sanna-Cherchi ◽

Sindu Krishna ◽

Ali Naini ◽

...

Keyword(s):

Magnetic Resonance ◽

Movement Disorder ◽

Brain Mri ◽

Brain Magnetic Resonance Imaging ◽

Mitochondrial Respiratory Chain ◽

Resonance Spectroscopy ◽

Homozygous Mutation ◽

Psychomotor Delay ◽

Mtdna Depletion ◽

Magnetic Resonance Imaging Mri

SUCLA2 defects have been associated with mitochondrial DNA (mtDNA) depletion and the triad of hypotonia, dystonia/Leigh-like syndrome, and deafness. A 9-year-old Brazilian boy of consanguineous parents presented with psychomotor delay, deafness, myopathy, ataxia, and chorea. Despite the prominent movement disorder, brain magnetic resonance imaging (MRI) was normal while 1H-magnetic resonance spectroscopy (MRS) showed lactate peaks in the cerebral cortex and lateral ventricles. Decreased biochemical activities of mitochondrial respiratory chain enzymes containing mtDNA-encoded subunits and mtDNA depletion were observed in muscle and fibroblasts. A novel homozygous mutation in SUCLA2, the first one in the ligase coenzyme A (CoA) domain of the protein, was identified. Escalating doses of CoQ10 up to 2000 mg daily were associated with improvement of muscle weakness and stabilization of the disease course. The findings indicate the importance of screening for mitochondrial dysfunction in patients with complex movement disorders without brain MRI lesions and further investigation for potential secondary CoQ10 deficiency in patients with SUCLA2 mutations.

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Relevance of hypointense brain MRI lesions for long-term worsening of clinical disability in relapsing multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/1352458513494490 ◽

2013 ◽

Vol 20 (2) ◽

pp. 214-219 ◽

Cited By ~ 25

Author(s):

Antonio Giorgio ◽

Maria Laura Stromillo ◽

Maria Letizia Bartolozzi ◽

Francesca Rossi ◽

Marco Battaglini ◽

...

Keyword(s):

Multiple Sclerosis ◽

Brain Mri ◽

Univariate Analysis ◽

Brain Lesion ◽

Brain Magnetic Resonance Imaging ◽

Stepwise Multiple Regression ◽

Lesion Volume ◽

Magnetic Resonance Imaging Mri ◽

Relapsing Remitting Multiple Sclerosis

Background: The accrual of brain focal pathology is considered a good substrate of disability in relapsing–remitting multiple sclerosis (RRMS). However, knowledge on long-term lesion evolution and its relationship with disability progression is poor. Objective: The objective of this paper is to evaluate in RRMS the long-term clinical relevance of brain lesion evolution. Methods: In 58 RRMS patients we acquired, using the same scanner and protocol, brain magnetic resonance imaging (MRI) at baseline and 10±0.5 years later. MRI data were correlated with disability changes as measured by the Expanded Disability Status Scale (EDSS). Results: The annualized 10-year lesion volume (LV) growth was +0.25±0.5 cm3 (+6.7±8.7%) for T2-weighted (T2-W) lesions and +0.20±0.31 cm3 (+11.5±12.3%) for T1-weighted (T1-W) lesions. The univariate analysis showed moderate correlations between baseline MRI measures and EDSS at 10 years ( p < 0.001). Also, 10-year EDSS worsening correlated with LV growth and the number of new/enlarging lesions measured over the same period ( p < 0.005). In the stepwise multiple regression analysis, EDSS worsening over 10 years was best correlated with the combination of baseline T1-W lesion count and increasing T1-W LV ( R = 0.61, p < 0.001). Conclusion: In RRMS patients, long-term brain lesion accrual is associated with worsening in clinical disability. This is particularly true for hypointense, destructive lesions.

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