[A case of bilateral infarction of medial pontomedullary junction]

A 69-year-old man suffered from dizziness and nausea after work, and was admitted to our hospital on the next day. On admission, he showed bilateral horizontal nystagmus and left hemiparesis. On the 3rd day he vomited frequently, and the dizziness became worse. Bilateral horizontal and upward gaze palsy and bilateral facial nerve palsy were observed. Brain MRI on the 5th day disclosed bilateral upper medial medullary infarction that extended to the pontomedullary junction. Cerebral angiography on the 13th day revealed occlusion of the right vertebral artery. This case did not show typical medial medullary syndrome. The mechanism was unknown, but similar cases were reported. Recently, many cases of medullary infarction are reported with the progress of MRI technology. It is suggested that the addition of the new concepts on the conventional syndromes of medullary infarction is necessary.