Giant \u201cheart appearance-like sign\u201d on MRI in bilateral ponto-medullary junction infraction: case report

Zhi-Hua Zhou,Ming-Fan Hong,Qing-Yun Yu,Zhong-Xing Peng,Wei-Feng Wu,Ai-Qun Liu,Yun-Fan Wu

doi:10.1186/s12883-020-01683-7

Zhi-Hua Zhou, Ming-Fan Hong + Show 5 more

Open Access

https://doi.org/10.1186/s12883-020-01683-7

Copy DOI

Journal: BMC Neurology	Publication Date: Mar 23, 2020
Citations: 5	License type: open-access

Affiliation: Guangdong Pharmaceutical University

Abstract

BackgroundBilateral medial medullary infarction (MMI) is uncommon and bilateral medial pons infarction (MPI) is even rarer. “Heart appearance” on magnetic resonance imaging (MRI) is a characteristic presentation of bilateral medial medullary infarction (MMI).Case presentationWe present 67-year-old Chinese diabetic and hypertensive female patient affected with “heart appearance-like” infarction in bilateral ponto-medullary junction on MRI. Abnormal signal was observed in the bilateral ponto-medullary junction on T1, T2, fluid-attenuated inversion recovery and apparent diffusion coefficient (ADC). The whole brain digital subtraction angiography (DSA) showed the basilar artery and vertebral artery remained intact. Therefore, we speculated that the bilateral ponto-medullary junction infarction might be caused by the deep perforating branch of the basilar artery.ConclusionsAs far as we know, the “heart appearance-like” infraction in bilateral ponto-medullary junction was not reported. Our case also suggests that bilateral ischemic infraction involvement of the medulla and pon is possible even in the context of an intact basilar artery.

Highlights

Bilateral medial medullary infarction (MMI) is uncommon and bilateral medial pons infarction (MPI) is even rarer
Our case suggests that bilateral ischemic infraction involvement of the medulla and pon is possible even in the context of an intact basilar artery
We present a patient affected with “heart appearance-like” infarction of the bilateral ponto-medullary junction on magnetic resonance imaging (MRI) and the whole brain digital subtraction angiography (DSA) showed the basilar artery (BA) and bilateral vertebral artery (VA) remained intact

Summary

Introduction

Bilateral medial medullary infarction (MMI) is uncommon and bilateral medial pons infarction (MPI) is even rarer. Conclusions: As far as we know, the “heart appearance-like” infraction in bilateral ponto-medullary junction was not reported. Background Bilateral medial medullary infarction (MMI) is uncommon, accounting for 0.5–1.51% of all strokes [1,2,3]. “Heart appearance” on magnetic resonance imaging (MRI) is a characteristic presentation of bilateral medial medullary infarction (MMI) [5,6,7].

Results

Conclusion