We present a patient with bilateral medial medullary infarction demonstrated by magnetic resonance imaging (MRI). A 70-year-old male suffered complete quadriplegia and bulbar palsy without impairment of deep sensation. The MRI on the 10th day revealed an infarcted lesion in the bilateral ventral half in the middle of the medulla oblongata. Three months later, atrophy in both lateral sides of the tongue was observed, which may suggest the involvement of a part of the Xllth nerve intranuclear fibers, excluding Xllth nerve nuclei. A review of the literature has disclosed that the combination of clinical signs described as typical in textbooks is not common among reported patients.