The ‘heart appearance’ sign in MRI in bilateral medial medullary infarction

• Published in: Postgraduate medical journal Vol. 87; no. 1024; pp. 156 - 157
• Main Authors: Krishnan, Mugundhan, Rajan, Palanivel, Kesavadas, Chandrasekharan, Iyer, Rajesh Shankar
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group 01.02.2011; Oxford University Press
• Subjects: Aged; Biological and medical sciences; Brain Stem Infarctions - diagnosis; Brain Stem Infarctions - therapy; Diabetes; General aspects; Heart; Humans; Hypertension; Magnetic Resonance Angiography - methods; Male; Medical sciences; Platelet Aggregation Inhibitors - therapeutic use; Treatment Outcome; Veins & arteries; Heart; Medicine; Infarct; Medical imagery; Bilateral; Circulatory system; Nuclear magnetic resonance imaging
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pgmj.2010.109538

Gaze-evoked horizontal nystagmus was also commonly observed in one analysis of 11 patients with MMI. 2 Hypertension, diabetes mellitus and hypercholesterolaemia were more commonly associated than embolism, indicating a strong relationship between atherosclerosis and MMI. The medial medullary territory is supplied by penetrating arterioles from the anterior spinal artery to the caudal medulla, and anteromedial arteries from the distal vertebral artery or proximal basilar artery to the rostral medulla. 3 MMIs are more commonly associated with vertebral artery occlusion, as observed in six of nine (67%) patients in one angiographic study. 4 An anomalous branch of a vertebral artery may supply both sides of the medial medullary area, occlusion of which could result in simultaneous bilateral medullary infarcts.