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August 02, 2016; 87 (5) Video NeuroImages

Complete lingual palsy from bilateral Dejerine syndrome (bilateral medial medullary stroke)

Spyridoula Tsetsou, Isabelle Beuchat, Inês Laginha, Patrik Michel
First published August 1, 2016, DOI: https://doi.org/10.1212/WNL.0000000000002926
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A 63-year-old man with several vascular risk factors presented with sudden left hemiplegia rapidly evolving to quadriparesis, dysarthria, bilateral hypoglossal palsy (video 1 on the Neurology® Web site at Neurology.org), and respiratory failure. IV thrombolysis with recombinant tissue plasminogen activator was administered. MRI confirmed bilateral medial medullary infarction (figure, A), and CT and magnetic resonance angiography showed right vertebral artery V4 occlusion, presumably atherosclerotic (figure, B). Tongue mobility recovered completely after 3 months (video 2).

Figure
Figure Imaging

(A) Diffusion-weighted-axial image: bilateral medial medullary infarct. (B) Magnetic resonance angiography: right V4 occlusion (white arrow).

Dejerine syndrome is a rare stroke syndrome; its bilateral form at the rostral level produces the characteristic “heart sign” on MRI1,2 (figure, A).

Footnotes

  • Supplemental data at Neurology.org

  • Author contributions: Dr. Tsetsou: drafting the manuscript, study concept, supervision and coordination. Dr. Beuchat: drafting the manuscript, literature search, video collection. Dr. Laginha: video collection. Dr. Michel: study supervision, corrections of the manuscript.

  • Study funding: No targeted funding reported.

  • Disclosure: The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

References

  1. 1.↵
    1. Pongmoragot J,
    2. Parthasarathy S,
    3. Selchen D,
    4. Saposnik G
    . Bilateral medial medullary infarction: a systematic review. J Stroke Cerebrovasc Dis 2013;22:775–780.
    OpenUrlPubMed
  2. 2.↵
    1. Tokuoka K,
    2. Yuasa N,
    3. Ishikawa T, et al.
    A case of bilateral medial medullary infarction presenting with “heart appearance” sign. Tokai J Exp Clin Med 2007;32:99–102.
    OpenUrlPubMed
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