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Giant "heart appearance-like sign" on MRI in bilateral ponto-medullary junction infraction: case report

Zhi-Hua Zhou1, Yun-Fan Wu2, Wei-Feng Wu3

  • 1Department of neurology, The first affiliated hospital, School of Clinical Medicine of Guangdong Pharmaceutical University, Guangzhou, Guangdong, China. zhouzh20051103@163.com.

BMC Neurology
|April 16, 2020
PubMed
Abstract

Insights

Bilateral ponto-medullary junction infarction, a rare condition, presented with a "heart appearance" on MRI. This case highlights potential causes beyond major artery blockages.

Area of Science:

  • Neurology
  • Neuroradiology
  • Vascular Neurology

Background:

  • Bilateral medial medullary infarction (MMI) and bilateral medial pons infarction (MPI) are rare neurological events.
  • The characteristic "heart appearance" on MRI is typically associated with MMI.

Observation:

  • A 67-year-old female patient presented with "heart appearance-like" infarction in the bilateral ponto-medullary junction on MRI.
  • Diffusion-weighted imaging and ADC maps revealed abnormal signals in the affected region.
  • Cerebral angiography confirmed intact basilar and vertebral arteries.

Findings:

  • This case reports a novel "heart appearance-like" infarction in the bilateral ponto-medullary junction.
  • The findings suggest infarction in the medulla and pons can occur bilaterally despite intact major arteries.

Implications:

  • The study suggests deep perforating branches of the basilar artery as a potential cause for such rare infarctions.
  • This case expands the understanding of ischemic stroke patterns in the brainstem.
Keywords:
Digital subtraction angiography (DSA)Heart appearanceMagnetic resonance image (MRI)Medial medullary infarction (MMI)Medial pons infarction (MPI)Ponto-medullary junction infraction

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