The heart sign in a patient with apparent locked-in syndrome
The present case has been published in the journal Neurology.
An 85-year-old man presented with 48 hours of recurrent vomiting and vertigo with rapidly progressive dysphagia and quadriplegia.

MRI revealed a paramedian medullary infarct, known as the heart sign, hallmark of this rare posterior circulation stroke caused by occlusion of the anterior spinal artery. Clinical presentation is determined by anteroposterior extension. Associated with quadriplegia, tongue weakness, and sensory loss, localized to the pyramidal tracts, hypoglossal nucleus, and medial lemniscus respectively.

This case correlates with pontine extension evidenced by recurrent vomiting, facial diplegia, and horizontal ophthalmoplegia, with the involvement of the area postrema, facial colliculus, and paramedian-pontine-reticular formation.