Medial medullary infarction with occlusion of distal vertebral arteryand basilar artery: A case report

Abstract

We report the case of a patient with a medial medullary infarction (MMI) associated with an occlusion of the vertebral artery and basilar artery. A 64-year-old man was admitted to our hospital because he complained of sudden muscle weakness on his right side and dysarthria while walking. Brain computed tomography (CT) showed no hemorrhagic lesions. Diffusion MR imaging showed a slight high-intensity lesion in the left medial medulla. He was given ozagrel and edaravone. After 6 days, diffusion MR imaging revealed a remarkably high-intensity lesion in the left medial medulla. After 7 days, cerebral angiography showed occlusion of the left distal vertebral artery (VA) and basilar artery, and this was diagnosed as an MMI because of an occlusion of the left distal VA. After 14 days, basi-parallel anatomical scanning MR imaging (BPAS-MRI) showed a stenosis of the left distal VA. These data suggested that the VA occlusion was caused by the stenosis with atherosclerosis. His neurological symptoms gradually improved. Distal VA atherosclerosis is an important vascular pathology, mostly giving rise to MMI by way of atherosclerosis branch occlusion. Our experience suggests that BPAS-MRI is an effective method to determine the mechanisms of MMI.