An unusual occurance medial medullary syndrome and hemiplegia cruciata; case report

Medial medullary syndrome (MMS) consists of ipsilateral lingual paresis, contralateral hemiparesis and lemniscal sensory loss. Hemiplegia cruciata (HC) consists of ipsilateral arm paresis and contralateral leg paresis. Both syndromes develop as a result of pathologies affecting V4 segment of the vertebral artery and anterior spinal artery. A 54-year-old man was admitted with left sided weakness. Neurological examination revealed left hemiparesis and right lingual paresis. Acute diffusion defect of anterior part of medulla oblongata was observed on Diffusion Weighted Imaging (DWI) and the patient was diagnosed with medial medullary syndrome. A month later, he developed another stroke causing a newly-emerging right arm paresis and progression of left leg paresis. DWI examination was repeated, which revealed an acute diffusion defect of craniocervical junction extending till third cervical vertebra. The patient was diagnosed with HC following MMS. We presented these two extremely rare syndromes which developed consecutively in a patient with stroke recurrence.