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Table of Contents    
Year : 2013  |  Volume : 61  |  Issue : 1  |  Page : 84-85

Bilateral medial medullary infarction: Heart appearance

1 Department of Radiodiagnosis, Yashoda Hospitals, Hyderabad, Andhra Pradesh, India
2 Department of Radiodiagnosis, Vijaya Diagnostics, Hyderabad, Andhra Pradesh, India
3 Department of Neurology, Yashoda Hospitals, Hyderabad, Andhra Pradesh, India

Date of Submission08-Dec-2012
Date of Decision08-Dec-2012
Date of Acceptance14-Dec-2012
Date of Web Publication4-Mar-2013

Correspondence Address:
Kirti Parsi
Department of Radiodiagnosis, Yashoda Hospitals, Hyderabad, Andhra Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.108023

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How to cite this article:
Parsi K, Itgampalli RK, Suryanarayana A, Kumar KR. Bilateral medial medullary infarction: Heart appearance. Neurol India 2013;61:84-5

How to cite this URL:
Parsi K, Itgampalli RK, Suryanarayana A, Kumar KR. Bilateral medial medullary infarction: Heart appearance. Neurol India [serial online] 2013 [cited 2021 Jan 21];61:84-5. Available from:


A 60-year-old hypertensive male presented with acute onset of slurred speech, weakness of right upper and lower limb followed by weakness of left upper limb and lower limb and difficulty in swallowing of 1-day duration. On examination he had bulbar palsy and quadriparesis. Magnetic resonance imaging (MRI) showed "heart shaped" restricted diffusion [Figure 1]a with low apparent diffusion coefficient (ADC) values [Figure 1]b with T2-wieghted sequence [Figure 1]c and FLAIR hyper intensities in the corresponding areas suggesting bilateral medial medullary infarction. MR-angiography [Figure 1]d showed signal drop in the right vertebral artery.
Figure 1: Diffusion weighted image (a) and apparent diffusion coefficient map (b) showing "heart shaped" restricted diffusion in bilateral ventral medulla. T2-weighted image (c) showing hyperintensities in medulla. MR-angiography (d) showing signal drop in the vertebral artery

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Bilateral medial medullary infarction (bilateral MMI) is an extremely rare form of posterior circulation stroke [1] and presents with quadriplegia as the initial symptom and is associated with poor functional prognosis. Before the MRI era bilateral MMI is sometimes misdiagnosed as Guillain-Barrι syndrome. MRI shows the classic heart-shaped infarct in ventral medulla. [2] The medulla oblongata is divided into anterior-medial territory, anterior-lateral territory, lateral territory, and posterior territory, according to vascular supply. Blood supply to these areas is by the vertebral artery and the anterior spinal artery, but it is often difficult to identify the occluded blood vessel because of the vastly complex network formed by these blood vessels. The "heart appearance" sign is considered to appear when the infarct occurs in the anterior-medial territory and anterior-lateral territory.The cause of the infarction is usually atherothrombosis of the vertebral or anterior spinal artery. [3]

  References Top

1.Bassetti C, Bogousslavsky J, Mattle H, Bernasconi A. Medial medullary stroke: Report of seven patients and review of the literature. Neurology 1997;48:882-90.  Back to cited text no. 1
2.Thijs RD, Wijman CA, van Dijk GW, van Gijn J. A case of bilateral medial medullary infarction bemonstrated by magnetic resonance imaging with diffusion-weighted imaging. J Neurol 2001;248:339-40.  Back to cited text no. 2
3.Bernasconi A, Bassetti C, Bogousslavsky J. Medial medullary stroke: Clinical-MRI study of 6 patients. Cerebrovasc Dis 1994;4:253.  Back to cited text no. 3


  [Figure 1]

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Lei Zhang,Gui-lian Zhang,Ju-mei Du,Zhu-lin Ma
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2 Bilateral Medial Medullary Stroke: A Challenge in Early Diagnosis
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