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A 62 year old man presented with a left hemiparesis, sparing the face and a right hypoglossal (CN XII) palsy. Sensation was intact.
Diffusion-weighted MRI scan. (Left) Lower medulla; (Right) Upper Medulla. Note the arrow points to a small area of infarction in the right medial medulla. Strokes of the medial medulla result in a classic "crossed" neurologic signs of an ipsilateral hypoglossal palsy and a contralateral hemiparesis. This is an uncommon lesion. The medial medulla is typically supplied by a branch of the anterior spinal artery, arising from the vertebral arteries.
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