title: Ischemic stroke of the pyramidal decussation causing quadriplegia and anarthria.
abstract: A 52-year-old man with a history of hypertension and previously irradiated head and neck cancer presented with quadriplegia and anarthria sparing the face and sensory functions. Brain magnetic resonance imaging (MRI) demonstrated acute infarction of the pyramidal decussation. We describe the clinical and radiological characteristics of infarction at the pyramidal decussation and review the arterial supply to this region in the lower brainstem. Although rare, infarction of the pyramidal decussation should be considered in the differential diagnosis when patients present with atraumatic pure motor quadriplegia.
authors.affiliation: Department of Neurology, University of California at San Francisco, San Francisco, California 94143-0114, USA.
authors.forename: Emilia G
authors.initials: EG
authors.lastname: Wilkins
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.forename: Eric C B
authors.initials: EC
authors.lastname: Johnson
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Shalev
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Josephson
mesh_terms: D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D002560:Cerebrovascular Circulation; D016371:Cranial Irradiation / Q000009:adverse effects*; D038524:Diffusion Magnetic Resonance Imaging; D004401:Dysarthria / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011712:Pyramidal Tracts / Q000098:blood supply*; D011782:Quadriplegia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000534:rehabilitation; D020521:Stroke / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D000071939:Stroke Rehabilitation