Fabry disease presenting as bilateral medial medullary infarction with a "heart appearance" sign: a case report

An analysis of clinical characteristics of rare bilateral medial medullary infarction: An observational study

This study aimed to characterize the risk factors, etiology, clinical manifestations, anatomical characteristics, stroke mechanisms, imaging features, and prognosis of bilateral medial medullary infarction (BMMI). A retrospective analysis was conducted on 11 patients with BMMI who met the inclusion criteria at the Affiliated Hospital of Xuzhou Medical University from January 2013 to January 2023. The patients' imaging and clinical features were analyzed and summarized. Eleven patients (7 male, 4 female), aged 46 to 62 years, met the inclusion criteria. Common clinical presentations included dysarthria (90.9%), dysphagia (90.9%), quadriplegia (81.8%), and so on. Within 72 hours of onset, 8 cases presented with quadriplegia, 2 cases with hemiplegia, and 1 case without limb paralysis. The main risk factor for BMMI was hypertension, followed by diabetes. "Heart appearance" infarcts occurred in 4 cases (36.4%), while "Y appearance" infarcts occurred in 7 cases (63.6%). Among the patients, 3 had unilateral vertebral artery stenosis or occlusion, 5 had bilateral vertebral artery stenosis or occlusion, 2 had normal vertebral basilar artery, and 1 did not undergo cerebrovascular examination. All patients received standardized treatment for cerebral infarction. The prognosis was poor, with 81.8% of patients having an unfavorable outcome, including 1 death, 9 cases of disability, and only 1 patient achieving self-care ability after recovery. BMMI is more prevalent in males aged 45 to 60 years. The main risk factors are hypertension and diabetes. Atherosclerosis is the primary etiological subtype. The main clinical manifestations are dyskinesia, dizziness, quadriplegia, and dysarthria. The prognosis of BMMI is poor. The specific imaging features of "heart appearance" or "Y appearance" infarcts aid in the diagnosis of BMMI.

Role of Acute Physiotherapy in Bilateral Medial Medullary Infarction: A Case Report

Bilateral medial medullary infarction (BMMI) is a rare stroke syndrome, which frequently has poor clinical outcomes. Reports on physical therapy for BMMI are few because of its poor prognosis. Therefore, this report aims to present a patient who developed BMMI and underwent well-considered rehabilitation. A 67-year-old man presented to our clinic with an acute onset of vomiting and dizziness. Magnetic resonance imaging (MRI) showed no abnormal signal intensity, and the patient was admitted for peripheral dizziness. On day two, he developed quadriplegia, bulbar palsy, and respiratory impairment, such as prolonged apnea. A second MRI revealed a high-intensity lesion in the bilateral medial medulla oblongata. He was diagnosed with BMMI, and rehabilitation treatment was initiated. On day 16, his sputum volume increased, and he could not expectorate effectively due to decreased coughing ability. Therefore, mechanical insufflation-exsufflation (MI-E) was performed to improve his airway clearance. On day 21, he developed aspiration pneumonia (AP), which became severe and led to acute respiratory failure. Nasal airway intubation and oxygen flow of 5 L/minute were initiated. His respiratory function was not seriously aggravated, and recurrent AP was prevented with the application of respiratory physiotherapy procedures, such as postural drainage, in collaboration with other medical staff, and MI-E. On day 60, the patient was transferred to the recovery phase rehabilitation ward. BMMI tends to worsen swallowing disorders progressively and is associated with a high risk of severe AP. Providing physiotherapy in the acute phase is important to reduce the risk of serious illness.

Unusual neurological manifestations of bilateral medial medullary infarction: A case report

Bilateral medial medullary infarction (BMMI) is an extremely rare type of cerebrovascular accident often resulting in poor functional consequences. “Heart appearance” on diffusion-weighted imaging (DWI) of magnetic resonance imaging (MRI) is the unique presentation of BMMI. In this article, we present an acute ischemic stroke patient whose brain MRI showed the atypical “heart appearance” sign, manifested unusual bilateral central facial paralysis concurrently. For an early diagnosis of BMMI, it is essential to recognize the characteristic clinical and MRI findings of this rare type of stroke. Abnormal small dot or linear DWI signal at the midline of the brainstem should not be ignored at the early stage of stroke.