Intravenous Thrombolysis in a Rare Case of Bilateral Medial Medullary Infarction

Abstract

Based on our PuBMed and Cochrane search, this is the first case report that describes the clinical outcome of thrombolysis in a rare case of bilateral medial medullary infarction. OBJECTIVE: To describe the outcome of thrombolysis in a frequently devastating bilateral medial medullary infarction. CLINICAL PRESENTATION: A 37-year-old Chinese male was seen at the emergency department four hours from symptom onset of sudden and rapidly progressing bilateral motor weakness with associated dizziness. The patient was seen awake, not in cardiorespiratory distress. Pupils were 3 millimeters isocoric and briskly reactive to light. Extraocular muscle movements were full and equal and there was torsional nystagmus on all gazes. There was right central facial palsy and weak gag reflex bilaterally. Tongue was midline on protrusion. Motor strength test revealed right sided hemiplegia and left sided hemiparesis (2-/5 on MMT). Bilateral Babinski sign was elicited. There was no sensory deficit to light touch. Magnetic resonance imaging of the brain showed acute infarction of the bilateral anteromedial medulla. TREATMENT AND OUTCOME: Alteplase was given at a dose of 0.7 mg/kg was given at exactly 4.5 hours post-ictus. There was no complication after thrombolysis. He was discharged on the 12th day post-ictus, still with dizziness but with improved muscle strength on all extremities to 3/5 MMT except for the right arm which remained paralyzed. He was able to tolerate oral feeding and had a Modified Rankin Scale score of 4.