Brainstem stroke in disguise: a case report of bilateral Dejerine syndrome

Abstract

Objective: To report a 67-year-old male patient with type 2 diabetes mellitus, arterial hypertension, and dyslipidemia, who developed bilateral Dejerine syndrome, a rare form of medial medullary infarction, as well as the appropriate treatment for the vascular event. Case report: Neurological symptoms were perceived by the patient in an insidious manner, resulting in diagnostic delay. In primary care, the condition was initially interpreted as Guillain-Barré syndrome, a hypothesis that was ruled out at a tertiary center due to incompatible clinical findings. The patient initially reported dysphonia, paresthesia, and paresis in the right lower limb, and days later noticed involvement of the contralateral hemibody, with tactile, vibratory, and painful hypoesthesia. Due to the persistence of deficits and diagnostic difficulty, he was referred for brain magnetic resonance imaging at a tertiary service, which demonstrated bilateral diffusion restriction in the medial portion of the medulla, compatible with Dejerine syndrome. The diagnosis was established by clinical–radiological correlation at our institution. Final considerations: Bilateral Dejerine syndrome is extremely rare, and early recognition of the clinical–radiological pattern is essential for management and prognosis, as it represents an ischemic stroke.