Pure motor quadriplegia due to bilateral medial medullary infarction

Left pure motor hemiplegia sparing the face occurred in a 54-year-old woman with a history of hypertension. After reduction of her blood pressure which had risen suddenly, right hemiparesis occurred. She had incomplete quadriplegia, but her face and tongue were spared. Although she complained of numbness in the left limbs, sensory examinations were normal for touch, pain, vibration and position sense. MRI demonstrated small infarctions confined to both pyramids of the upper medulla oblongata, that partially extended to the anterior margin of the right medial lemniscus. Cerebral angiography did not reveal significant abnormalities. Bilateral infarction of the medullary pyramids resulting in pure motor quadriplegia is a rare occurrence. The extension of the deficit noted in this case could have been due to failure of the collateral circulation elicited by lowering of the blood pressure.