Stroke Mimicking Peripheral Neuropathy or Myelopathy: Bilateral Medial Medullary Infarct

Bilateral medial medullary infarcts are rare, but clinicians need to be aware of their presentation so that treatment is not delayed. Diagnostic difficulty occurs because of atypical stroke features such as glove-and-stocking sensory impairment, quadraparesis, facial sparing, and sub-acute progression—that can resemble Guillain-Barre syndrome (acute inflammatory demyelinating polyneuropathy) or cervical myelopathy. We report a case of staggering-onset flaccid quadriparesis over 12 h, distal numbness in all four limbs, with progressive ascension on one side followed by ascension on the other side (“N-shaped” pattern). Upbeat nystagmus, while pathognomonic for brainstem involvement, only occurred later.