"Heart appearance" infarction of the pons: a case report.

[locked-in syndrome]

"Heart appearance " on magnetic resonance imaging (MRI ) is a unique presentation of bilateral medial medullary infarction . In contrast , "heart appearance " infarction of the pons has rarely been featured in the medical literature . In this paper , we present a case of "heart appearance " infarction of the pons with its MRI and magnetic resonance angiography (MRA ) findings . The patient was an 87 -year -old male who manifested with weakness in the four extremities . Later , bulbar palsy and tetraplegia became apparent , and he eventually was trapped in locked-in syndrome . Brain MRI disclosed a "heart appearance " lesion in the pons , which was high on diffusion-weighted image MRI and low on apparent diffusion coefficient map MRI . Brain MRA demonstrated that the basilar artery remained intact . A diagnosis of fresh , bilateral pontine infarction with a "heart appearance " was made . After the treatment he was transferred to another hospital for long -term care . This case suggests that bilateral ischemic involvement of the pons is possible even in the context of an intact basilar artery .