Advertisement
Letter to the Editor| Volume 352, ISSUE 1-2, P135-136, May 15, 2015

Download started.

Ok

Bilateral medial medullary infarction presenting as Guillain Barré Syndrome: A diagnostic challenge

Published:April 09, 2015DOI:https://doi.org/10.1016/j.jns.2015.03.048
      Medial medullary infarction (MMI) is an uncommon entity (0.5–1.5% of all strokes), and bilateral MMI is extremely rare [
      • Krishnan M.
      • Rajan P.
      • Kesavadas C.
      • Iyer R.S.
      The ‘heart appearance’ sign in MRI in bilateral medial medullary infarction.
      ,
      • Pongmoragot J.
      • Parthasarathy S.
      • Selchen D.
      • Saposnik G.
      Bilateral medial medullary infarction: a systematic review.
      ]. Although quadriparesis, loss of deep sensation and hypoglossal palsy have been described as the classical picture for bilateral MMI, the clinical presentation is variable and non-specific, usually delaying diagnosis [
      • Pongmoragot J.
      • Parthasarathy S.
      • Selchen D.
      • Saposnik G.
      Bilateral medial medullary infarction: a systematic review.
      ]. Moreover, initial diffusion weighted imaging (DWI) is often negative [
      • Watts J.
      • Wood B.
      • Kelly A.
      • Alvaro A.
      Stroke syndromes associated with DWI-negative MRI include ataxic hemiparesis and isolated internuclear ophthalmoplegia.
      ]. Bilateral MMI can be misdiagnosed as Guillain Barré Syndrome (GBS), since patients present with sudden onset of quadriparesis, sensory disturbances, bulbar dysfunction and progression to respiratory failure [
      • Pongmoragot J.
      • Parthasarathy S.
      • Selchen D.
      • Saposnik G.
      Bilateral medial medullary infarction: a systematic review.
      ,
      • Ma L.
      • Deng Y.
      • Wang J.
      • Du F.
      • Xia F.
      • Liu Y.
      • et al.
      Bilateral medial medullary infarction presenting as Guillain–Barré-like syndrome.
      ]. We present a case of DWI-negative bilateral MMI, initially thought to be GBS.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Krishnan M.
        • Rajan P.
        • Kesavadas C.
        • Iyer R.S.
        The ‘heart appearance’ sign in MRI in bilateral medial medullary infarction.
        Postgrad Med J. 2011; 87: 156-157
        • Pongmoragot J.
        • Parthasarathy S.
        • Selchen D.
        • Saposnik G.
        Bilateral medial medullary infarction: a systematic review.
        J Stroke Cerebrovasc Dis. 2013; 22: 775-780
        • Watts J.
        • Wood B.
        • Kelly A.
        • Alvaro A.
        Stroke syndromes associated with DWI-negative MRI include ataxic hemiparesis and isolated internuclear ophthalmoplegia.
        Neurology. 2013; 3: 186-191
        • Ma L.
        • Deng Y.
        • Wang J.
        • Du F.
        • Xia F.
        • Liu Y.
        • et al.
        Bilateral medial medullary infarction presenting as Guillain–Barré-like syndrome.
        Clin Neurol Neurosurg. 2011; 113: 589-591
        • Kleinert G.
        • Fazekas F.
        • Kleinert R.
        • Schmidt R.
        • Payers F.
        • Offenbacher H.
        • et al.
        Bilateral medial medullary infarction: magnetic resonance imaging and correlative histopathologic findings.
        Eur Neurol. 1993; 33: 74-76
        • Maeda M.
        • Shimono T.
        • Tsukahara H.
        • Maier S.E.
        • Takeda K.
        Acute bilateral medial medullary infarction: a unique ‘heart appearance’ sign by diffusion-weighted imaging.
        Eur Neurol. 2004; 51: 236-237
        • Brazis P.W.
        • Masdeu J.C.
        • Biller J.
        Localization in clinical neurology.
        Lippincott Williams & Wilkins, 2012
        • Kim J.S.
        • Kim H.G.
        • Chung C.S.
        Medial medullary syndrome report of 18 new patients and a review of the literature.
        Stroke. 1995; 26: 1548-1552
        • Yuki N.
        • Hartung H.-P.
        Guillain–Barré syndrome.
        N Engl J Med. 2012; 366: 2294-2304
        • Tai M.-L.S.
        • Katiman E.
        • Rahmat K.
        • Tan C.T.
        Acute bilateral medial medullary infarct with hypoplastic vertebral artery.
        Clin Neurol Neurosurg. 2012; 114 ([Tai, 2012 #38]): 1365-1367