We report a 63-year-old man with consecutive, bilateral, and symmetrical Corona Radiata infarcts within 4 weeks duration, who presented with quadriparesis in addition to acute onset anarthria, and facio-labio-glosso-pharyngo-laryngeal paralysis. To our knowledge, there are no reported cases of recurrent lacunar stroke affecting the same area in the contralateral hemisphere as seen in our case.

Stroke is a leading cause of death and disability in the United states and particularly in our region; western New york. Around ¼ of annual strokes are recurrent strokes. It is important to identify clinical stroke syndromes to prevent any delays in care and possible clinical deterioration associated with that delay.

A 63 year-old-male with a recent history of left corona radiata stroke with residual right-sided weakness was evaluated by the neurology team for acute onset anarthria, tongue hypotonia, difficulty with chewing, swallowing and mastication along with quadriplegia. Patient was unable to open mouth on command but was able to yawn. Brain MRI revealed an acute right corona radiata infarct, a mirror image of the recent left corona radiata infarct.Gradually, upper motor neuron signs start to appear on day 2.

Our patient suffered an acute left corona radiation infarct, almost perfectly symmetrical to a subacute right corona radiata infarct that occurred a month prior. Due to involvement of bilateral posterior limb of internal capsule, initial presentation was acute flaccid paralysis with quadriparesis and cranial neuropathy. Initial working diagnosis was acute neuromuscular disorder rather than stroke due to clincal presentation. Loss of bilateral symmetrical neural impulse can lead to atypical presentation in acute state.