‘Wrong side’ tongue deviation in hemiplegia due to stroke

A previously healthy 10 year-old right-handed boy presented with acute left arm and left leg weakness soon after exercises during football practice. Examination revealed dense left-sided hemiplegia sparing the face associated with ipsilateral tongue deviation (Figure 1 A), vertical upbeat nystagmus, left sided hyporeflexia and a left Babinski reflex. Magnetic resonance imaging (MRI) of brain and cervical cord showed restricted diffusion and the corresponding hypointesity in ADC (apparent diffusion coefficient) at left caudal anterior medulla and left antero-lateral cervico-medullary junction due to acute ischemic infarction in left anterior spinal artery distribution (Figure 1 B,C).
Source: Pediatric Neurology - Category: Neurology Authors: Tags: Visual Diagnosis Source Type: research