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Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion.

Publication ,  Journal Article
Searcy, S; Akinduro, OO; Spector, A; Yoon, JW; Brown, BL; Freeman, WD
Published in: Neurocrit Care
June 2018

BACKGROUND: Unilateral anterior spinal artery (ASA) occlusion resulting in bilateral medullary pyramidal (BMP) infarction is a rare and devastating stroke subtype. We present two cases highlighting the diagnostic and clinical challenges of BMP infarction. METHODS: Case reports and literature review. RESULTS: A 57-year-old man rapidly had severe vomiting and diarrhea 2 h after a meal. Examination revealed bulbar weakness and areflexic tetraplegia. Respiratory failure developed, requiring intubation and mechanical ventilation. Brain magnetic resonance imaging (MRI) showed a heart-shaped region of diffusion abnormality, characteristic of BMP infarction. Cerebral angiography showed an occluded left vertebral artery with unilateral left-sided origin of ASA. The patient required tracheostomy and percutaneous gastrostomy tube and was discharged to rehabilitation, with little improvement of his tetraplegia at 3-month follow-up. A 43-year-old woman presented to the emergency department with acute onset of lower-extremity paresthesia and history of upper respiratory infection 2 weeks prior. Initial examination findings included bulbar weakness, dysphagia, hyporeflexia, and generalized weakness. After admission, she had severe respiratory distress and required intubation. Lumbar puncture was evaluated for Guillain-Barré syndrome, but cerebrospinal fluid protein concentration was normal. Changes on diffusion-weighted MRI of the brain showed the characteristic heart-shaped BMP infarction, indicating occlusion of a unilateral ASA. She required tracheostomy and percutaneous gastrostomy tube placement, with no paralysis resolution. CONCLUSION: Acute BMP infarction may present with flaccid tetraplegia mimicking neuromuscular disorders. When the infarction is recognized early, intravenous thrombolysis can be considered to reduce morbidity of this rare stroke subtype.

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Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

June 2018

Volume

28

Issue

3

Start / End Page

388 / 394

Location

United States

Related Subject Headings

  • Vertebral Artery
  • Neurology & Neurosurgery
  • Middle Aged
  • Medulla Oblongata
  • Male
  • Humans
  • Cerebral Infarction
  • Arterial Occlusive Diseases
  • Adult
  • 4205 Nursing
 

Citation

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ICMJE
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Searcy, S., Akinduro, O. O., Spector, A., Yoon, J. W., Brown, B. L., & Freeman, W. D. (2018). Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion. Neurocrit Care, 28(3), 388–394. https://doi.org/10.1007/s12028-017-0406-7
Searcy, Sammy, Oluwaseun O. Akinduro, Andrew Spector, Jang W. Yoon, Benjamin L. Brown, and William D. Freeman. “Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion.Neurocrit Care 28, no. 3 (June 2018): 388–94. https://doi.org/10.1007/s12028-017-0406-7.
Searcy S, Akinduro OO, Spector A, Yoon JW, Brown BL, Freeman WD. Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion. Neurocrit Care. 2018 Jun;28(3):388–94.
Searcy, Sammy, et al. “Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion.Neurocrit Care, vol. 28, no. 3, June 2018, pp. 388–94. Pubmed, doi:10.1007/s12028-017-0406-7.
Searcy S, Akinduro OO, Spector A, Yoon JW, Brown BL, Freeman WD. Heart-Shaped Bilateral Medullary Pyramidal Infarction as a Pathognomonic Finding of Anterior Spinal Artery Occlusion. Neurocrit Care. 2018 Jun;28(3):388–394.
Journal cover image

Published In

Neurocrit Care

DOI

EISSN

1556-0961

Publication Date

June 2018

Volume

28

Issue

3

Start / End Page

388 / 394

Location

United States

Related Subject Headings

  • Vertebral Artery
  • Neurology & Neurosurgery
  • Middle Aged
  • Medulla Oblongata
  • Male
  • Humans
  • Cerebral Infarction
  • Arterial Occlusive Diseases
  • Adult
  • 4205 Nursing