[Acute medullary infarct: a still little know diagnosis with a poor prognosis]

Medullary infarct is still little known influencing the short-term vital and functional prognosis of patients. Medullary vascularization is one of the most complex in the body due to the significant number of arteries that contribute to it. Our knowledge is still limited due to the scarcity of vascular medullary accidents and to low accessibility of medullary vessels during assessments. We report the case of a 62-year old patient with type 2 diabetes and a 13-year history of oral antidiabetic treatment who had been followed-up for psoriasis for 4 years. He presented to hospital in the night with his son due to acute onset of upper limb deficit. This deficit was preceded by acute onset of neck pain during his daily prayer. On admission, the patient was conscious, arterial pressure 120/86mmhg, heart rate 89 beat/min, afebrile. Clinical examination showed flaccid brachial diplegia. There was no sensory disorder or sphincteric disorder and cranial nerve examination was normal. Emergency medullary MRI was performed which showed T2 hyperintense signal and "snake-eyes"-like bilateral central dissemination (A and B). Etiological assessment showed therosclerotic patches at the origin of the left internal carotid artery. The diagnosis of myocardial infarct associated with medullary fibrocartilaginous embolism was retained. Functional rehabilitation was started early as well as treatment with platelet aggregation inhibiting drugs.