Perioperative Bilateral Medial Medullary Infarction With “Snake Eyes Appearance”: A Case Report

Perioperative bilateral medial medullary infarction (BMMI) cases mimicking acute motor axonal neuropathy (AMAN) under general anesthesia have not been reported. We describe a patient who suffered flaccid quadriplegia and could not wean from mechanical ventilation after emergence from general anesthesia in cardiac surgery. A diagnosis of AMAN was considered, but intravenous immunoglobulin showed little efficacy. Magnetic resonance imaging of the patient later revealed BMMI with “snake eyes appearance,” and he was found to have severe vertebral artery stenosis. Considering the association between severe coronary heart disease and cerebrovascular stenosis, we highlight the significance of preoperative evaluation and comprehensive management of the cerebrovascular system for certain patients.

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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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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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Magnetic resonance imaging of medial medullary infarction.

Stroke ◽

10.1161/01.str.21.6.963 ◽

1990 ◽

Vol 21 (6) ◽

pp. 963-966 ◽

Cited By ~ 7

Author(s):

H Sawada ◽

N Seriu ◽

F Udaka ◽

M Kameyama

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Medial Medullary Infarction ◽

Medullary Infarction

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Spectrum of medial medullary infarction: clinical and magnetic resonance imaging findings

Journal of Neurology ◽

10.1007/pl00007852 ◽

2002 ◽

Vol 249 (1) ◽

pp. 85-93 ◽

Cited By ~ 43

Author(s):

Emre Kumral ◽

Nazire Afsar ◽

Dursun Kırbas ◽

Kaan Balkır ◽

Tolga Özdemirkıran

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Imaging Findings ◽

Resonance Imaging ◽

Medial Medullary Infarction ◽

Medullary Infarction

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Heart sign in Neurology - A Radiological sign

Nepal Journal of Neuroscience ◽

10.3126/njn.v17i2.30165 ◽

2020 ◽

Vol 17 (2) ◽

pp. 48-50

Author(s):

Sheetal Sajan ◽

Reji Thomas

Keyword(s):

Magnetic Resonance Imaging ◽

Radiological Sign ◽

Brainstem Encephalitis ◽

Resonance Imaging ◽

Mri Brain ◽

Medial Medullary Infarction ◽

The Common ◽

Weighted Sequences ◽

Shaped Pattern ◽

Medullary Infarction

Bilateral medial medullary infarction is a rare stroke syndrome. The common symptoms are quadriparesis, dysarthria and hypoglossal palsy. However, the early diagnosis of bilateral medial medullary infarction may be difficult as it may mimic other conditions like Guillain Barre syndrome and brainstem encephalitis. With the advent of magnetic resonance imaging, it can be easily diagnosed, as the diffusion weighted sequences demonstrate hyperintensity involving bilateral medulla in a heart shaped pattern, described as the “Heart sign”. We hereby report a patient who presented with progressive quadriparesis, and dysarthria, progressing to respiratory failure, whose MRI brain showed the characteristic “heart sign” on diffusion sequences and was diagnosed to have bilateral medial medullary infarction.

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