Presentation
Dysarthria, left upper limb weakness, unsteady on feet.
Patient Data
There is diffusion restriction involving the right medial medulla in keeping with a recent infarction, clearly demarcated by the midline. Absent flow void within the right vertebral artery is suspicious for thrombus.
Multiple tiny foci of T2 hyperintensities involving the subcortical white matter likely represent moderate small vessel disease.
Case Discussion
Medial medullary syndrome results from infarction of the medial aspect of the medulla and affects the include hypoglossal nerve fibers, medial lemniscus and medullary pyramid which contains corticospinal fibers. This results in contralateral motor weakness, contralateral sensory dysfunction and ipsilateral hypoglossal nerve palsy.
Generally, the spinothalamic tract is located more lateral within the brainstem and is therefore spared.
In this case, medial medullary infarction was caused by thrombosis of the right V4, an important reminder to always check vascular flow voids.