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Hu F, Nie H, Bai Y, Liang X, Li L, Shen Y. The stroke mechanism, clinical presentation, and radiological feature of bilateral medial medullary infarction. Neurol Sci 2022; 43:6881-6888. [DOI: 10.1007/s10072-022-06382-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
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Zheng R, Zhang T, Zeng X, Yu M, Jin Z, Zhang J. Unusual neurological manifestations of bilateral medial medullary infarction: A case report. Open Med (Wars) 2022; 17:119-123. [PMID: 35071773 PMCID: PMC8724358 DOI: 10.1515/med-2021-0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022] Open
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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Affiliation(s)
- Ruizhi Zheng
- Department of Neurology, The Third Central Clinical College of Tianjin Medical University , Tianjin 300170 , China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases , Tianjin , China
- Artificial Cell Engineering Technology Research Center , Tianjin , China
- Tianjin Institute of Hepatobiliary Disease , Tianjin , China
| | - Ting Zhang
- Department of Neurology, The Third Central Clinical College of Tianjin Medical University , Tianjin 300170 , China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases , Tianjin , China
- Artificial Cell Engineering Technology Research Center , Tianjin , China
- Tianjin Institute of Hepatobiliary Disease , Tianjin , China
| | - Xianzhu Zeng
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases , Tianjin , China
- Artificial Cell Engineering Technology Research Center , Tianjin , China
- Tianjin Institute of Hepatobiliary Disease , Tianjin , China
- Department of Neurology, The Third Central Clinical College of Tianjin Medical University , Tianjin 300170 , China
| | - Miao Yu
- Tianjin Key Laboratory of Cerebrovascular and Neurodegenerative Diseases, Tianjin Dementia Institute, Department of Neurology, Tianjin Huanhu Hospital , Tianjin 300350 , China
| | - Zhao Jin
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases , Tianjin , China
- Artificial Cell Engineering Technology Research Center , Tianjin , China
- Tianjin Institute of Hepatobiliary Disease , Tianjin , China
- Department of Neurology, The Third Central Clinical College of Tianjin Medical University , Tianjin 300170 , China
| | - Jing Zhang
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases , Tianjin , China
- Artificial Cell Engineering Technology Research Center , Tianjin , China
- Tianjin Institute of Hepatobiliary Disease , Tianjin , China
- Department of Neurology, The Third Central Clinical College of Tianjin Medical University , Tianjin 300170 , China
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Fazal ST, Mahajan A, Mehta S. White Heart in Pons—A Rare Imaging Sign in Bilateral Pontine Infarction. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1739344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Syed T. Fazal
- Department of Radiodiagnosis, Artemis Hospital, Gurgaon, Haryana, India
| | - Ashima Mahajan
- Department of Radiodiagnosis, Artemis Hospital, Gurgaon, Haryana, India
| | - Sanjay Mehta
- Department of Radiodiagnosis, Artemis Hospital, Gurgaon, Haryana, India
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Mantese CEA, Pontalti M, Guerreiro A, Klamt C. Sequential Pontine Strokes With the "Heart Appearance" Sign. Cureus 2021; 13:e15025. [PMID: 34150381 PMCID: PMC8202785 DOI: 10.7759/cureus.15025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Most brainstem infarcts are caused by pontine strokes. When a bilateral pontine or brainstem stroke occurs, it can result in an image called the “heart appearance” sign. Sequential pontine strokes have not yet been described to cause the “heart appearance” sign. We report a case of sequential pontine strokes in a 47-year-old man with no relevant medical history. He presented with acute left-sided hemiparesis. Initial brain MRI showed a right-sided pontine infarction. Two weeks later, the patient’s left side hemiparesis and dysarthria worsened, and he developed right-sided facial paralysis. The brain MRI showed a left-sided pontine infarction that looked like the “heart appearance” sign. The patient had a good recovery. This report highlights a case of atypical pontine stroke recurrence two weeks apart and discusses branch artery disease as a possible etiologic cause.
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