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A 41-year-old man with progressive quadriparesis

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Presentation on theme: "A 41-year-old man with progressive quadriparesis"— Presentation transcript:

1 A 41-year-old man with progressive quadriparesis
Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

2 Vignette A 41-year-old man with progressive quadriparesis and generalized tingling sensation showed spontaneous upbeating nystagmus and horizontal gaze-evoked nystagmus. Lee, et al. © 2017 American Academy of Neurology

3 Imaging Figure. Initial and follow-up MRIs. Diffusion-weighted images obtained six hours after symptom onset did show an equivocal hyperintensity in the rostral medial medulla oblongata (upper row). Follow-up images obtained two days later exhibit a “heart appearance” sign extending to the dorsal medulla (lower row). Lee, et al. © 2017 American Academy of Neurology

4 Video Video. The video shows spontaneous upbeat and horizontal gaze-evoked nystagmus. The upbeat nystagmus was predominant during visual fixation. Horizontal gaze-evoked nystagmus was induced during bilateral gaze. The upbeat nystagmus was increased during upward and bilateral gaze and decreased during downward gaze. LH=horizontal position of the left eye, LV=vertical position of the left eye, LT=torsional position of the left eye. Lee, et al. © 2017 American Academy of Neurology

5 Upbeat and Horizontal Gaze-evoked Nystagmus in Bilateral Medial Medullary Infarction
Since motor weakness can be progressively presented and the MRI findings can be equivocal in the acute stage of bilateral medial medullary infarction, patients who have progressive quadriplegia with normal consciousness may be misdiagnosed as Guillain-Barre syndrome or its variants. The nystagmus suggesting a central origin may be helpful for early diagnosis in this setting. REFERENCES 1. Pongmoragot J, Parthasarathy S, Selchen D, Saposnik G. Bilateral medial medullary infarction: a systematic review. J Stroke Cerebrovasc Dis 2013;22:775–780. 2. Ma L, Deng Y, Wang J, Du F, Xia F, Liu Y, Li X. (2011). Bilateral medial medullary infarction presenting as Guillain-Barré-like syndrome. Clin Neurol Neurosurg 2011;113:589–591. Lee, et al. © 2017 American Academy of Neurology

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