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

We report a patient with bilateral medial medullary infarctions, which is a rare type of ischemic stroke. A 64-year-old Japanese man demonstrated bilateral hemiplegia, sensory dysfunction, ataxia, and dysphagia. The left-dominant but bilateral medial medulla lesions indicated hyperintensity on the T2-weighted image at 1.5 months after the onset. On the time-of-flight magnetic resonance angiography (TOF-MRA) performed at the onset, the right vertebral artery was partially narrowed and the left vertebral artery was not confirmed. Basi-parallel anatomical scanning-magnetic resonance imaging (BPAS-MRI) revealed that both sides of the vertebral arteries had a uniform diameter, which means there was no arterial hypoplasia nor arterial dissection. These results suggest that atherosclerosis in the bilateral vertebral artery caused occlusion of the perforator artery, resulting in the bilateral medial medullary infarctions. The combined use of TOF-MRA and BPAS-MRI could help improve the accuracy of diagnosis and be helpful for post-stroke management.