{
  "abstract": "Background Bilateral medial medullary infarction (MMI) is a rare and devastating stroke syndrome often involving progressive bilateral weakness, bulbar dysfunction, loss of deep tendon reflexes and respiratory failure.Results A 70-year-old male presented to the emergency department with a two-day history of dysarthria, upper limb weakness and gait disturbance. Initial examination findings revealed bulbar weakness, hyporeflexia and generalised weakness. Over 24 hours he progressed to areflexic tetraplegia with severe respiratory failure requiring intubation and mechanical ventilation. CT non-contrast was unremarkable and contrast allergy precluded CT angiography and perfusion studies. Cerebrospinal fluid protein was elevated to 0.95g/L, and diagnosis of Guillain-Barre Syndrome was considered. Plasma exchange was commenced with no improvement in symptoms. Diffusion weighted MRI demonstrated a characteristic ‘heart-shaped’ area of restricted diffusion in the medial medulla in keeping with acute infarction.Conclusion This case highlights (i) the diagnostic challenge associated with MMI given its propensity to mimic other common pathologies and (ii) the importance of rapid identification and treatment given its potentially devastating outcome.",
  "authors": [
    {
      "affiliations": [
        "Neurology Department, Liverpool Hospital, Sydney, NSW, Australia"
      ],
      "name": "Jeremy F Kellie"
    },
    {
      "affiliations": [
        "Neurology Department, St. Vincent’s Hospital, Sydney, NSW, Australia"
      ],
      "name": "Sarika Suresh"
    },
    {
      "affiliations": [
        "Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia"
      ],
      "name": "Toh Wong"
    }
  ],
  "title": "3641 Bilateral medial medullary infarct",
  "uid": "97d8618d-00a7-5312-86e2-80a74e28d39f"
}