PMC6345094_01
MR images show right medial pontomedullary junctional infarction: Each T2-weighted image (A), a fluid attenuation inversion recovery image (B), a diffusion weighted image (C) and an apparent diffusion coefficient map (D) indicate fresh ischemic lesion in axial sections. Sagittal sections of T2-weighted image (E) and diffusion weighted image (F) demonstrated, to the letter, pontomedullary junctional infarction
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MPMJ (Fig. 1E and F). MR angiography did not show vertebrobasilar arterial dissection, severe thrombosis, nor apparent vasospasm (Fig. 2). This right MPMJ infarction (Fig. 1E and F) caused right transient peripheral type facial paresis (Fig. 3, upper), left side
In comparison with the presymptomatic state (A), MR angiography shows no vertebrobasilar dissection or vasospasm/vasoconstriction but slightly stenotic change in the left vertebral artery on Day 03 (upper) with resolution on Day 17 (lower)
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MPMJ (Fig. 1E and F). MR angiography did not show vertebrobasilar arterial dissection, severe thrombosis, nor apparent vasospasm (Fig. 2).
The right peripheral type facial paresis shows improvement gradually (upper). Extraocular movements show full range in all directions. The patient can protrude the tongue over the teeth without deviation from midline
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Although her facial paresis ameliorated over the first week (Fig. 3, upper), her dysphagia did not. TH of the body and face and severe dysphagia. The infarction (Fig. 4) did not cause lateral gaze palsy as right abducents palsy (Fig. 3, lower), hoarseness as glossopharybngeal nerve palsy, Horner's syndrome/curtain sign as vagus nerve palsy, or tongue deviation as hypoglossal nerve palsy (Fig. 3, lower), or left hemiparesis.
A magnified T2-weighted axial image shows localized infarction in the right pontomedullary junction
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TH of the body and face and severe dysphagia. The infarction (Fig. 4) did not cause lateral gaze palsy as right abducents palsy (Fig. 3, lower), hoarseness as glossopharybngeal nerve palsy, Horner's syndrome/curtain sign as vagus nerve palsy, or tongue deviation as hypoglossal nerve palsy (Fig. 3, lower), or left hemiparesis.
Anteroposterior view pictures of a videofluorography (50 flames per second, upper row) on the 25th day after onset show the laterality of the hypopharyngeal pyriform sinus during swallowing. They clearly show hypopharyngeal dysfunction in the left side. Cricopharyngeal achalasia (arrows) regresses over 4 weeks in synchronization with the recovery of thermal hypalgesia (lower row)
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Videofluorographic examinations showed consistent recovery from dysphagia caused by cricopharyngeal sphincter achalasia, evidenced by her improved ability to swallow (Fig. 5).