Medial medullary infarction with central sparing

Abstract

A 35-year-old woman had cardiac arrest requiring treatment with a left ventricular assist device. After regaining consciousness, examination revealed upbeating nystagmus, otherwise normal bulbar function, left arm dysmetria, and numbness periorally and in areas she described as "a turtleneck of numbness with a T-shirt of sensation" (figure 1).

Figure 1. Shaded areas indicate regions of decreased sensation

Figure 2. Brain MRI

(A) Axial diffusion-weighted imaging and (B) apparent diffusion coefficient mapping show a ring-like area of ischemia involving the medial medulla with central sparing.