Troubles neurologiques

The Heart-sign of Bilateral Medial Medullary Infarction

Abstract

Pedro Radalle Biasi, Grégori Manfroi, Timóteo Abrantes de Lacerda Almeida, Luciano Bambini Manzato

The Bilateral Medial Medullary Infarction presents with progressive tetraparesis, bilateral profound sensory loss, dysphagia and dysarthria, progressing to respiratory failure, which can be misdiagnosed with Guillain-Barré syndrome. The main cause its vertebral artery atherosclerosis and thrombosis affecting the anteromedial (supplied by branches of vertebral artery and anterior spinal artery) and anterolateral (fed by short and long transverse branches of vertebral artery) territories of medulla bilaterally. The diagnosis is facilitated by Diffusion Weighted Image and ADC-map on MRI, which shows a V-shape infarction, or, as known, the “heart sign” (Figure 1 and Figure 2), which is typical of this disease. The outcome is poor, with high mortality.