Bilateral medial medullary syndrome secondary to Takayasu arteritis

Abstract

Medial medullary syndrome (MMS) is a rare type of stroke which results due to occlusion of the anterior spinal artery or vertebral artery or its branches. In this case report we present a patient who developed MMS secondary to Takayasu arteritis (TA). TA is a chronic inflammatory arteritis primarily involving the arch of aorta and its branches, which in our patient resulted in occlusion of subclavian arteries as well as infarction of the medial medulla bilaterally. To our knowledge this is the first time that MMS has been found to occur secondary to TA.

Figure 1

An MRI brain showing hyperintense signal changes in diffusion weighted (A) as well as T2-weighted imaging (B) involving the medial medulla bilaterally suggestive of acute infarct.

Figure 2

Digital subtraction angiogram with injection of the brachiocephalic trunk showing occlusion of the right subclavian artery with non-visualisation of the right vertebral artery and normal right carotid artery (A); injection of the left subclavian shows occlusion of the vessel with poor filling of the left vertebral artery (B).

Figure 3

(A) Schematic diagram of an axial section of the medulla with recognised anatomical structures; in addition, a theoretical depiction of the aberrant descending and ascending corticofacial loop fibres (labelled in bold and italics) is shown. The shaded regions represent the possible area of infarction in this patient. (B) Schematic diagram of a coronal section of the entire brainstem showing the descending corticofacial fibres as well as the aberrant corticofacial fibres which descend into the medulla. Involvement of this aberrant loop can lead to facial palsy in a medullary lesion.