Bilateral medial medullary stroke: "The heart sign"

Bilateral medial medullary stroke is a very rare condition. It is usually associated with severe motor deficits, dysarthria, sensory symptoms, nystagmus, and respiratory disturbances. The most common etiology is atherosclerotic disease of the vertebral and anterior spinal artery or its branches. We present the case and brain imaging of a 48-year-old man with a bilateral medial medullary stroke and its classic "Heart Sign" in the magnetic resonance imaging. This case highlights the anatomy of the rostral medulla, clinical presentation, etiology, and characteristic radiologic findings of this uncommon type of stroke.