A 58-year-old man develops sudden onset of ipsilateral Horner syndrome, loss of pain and temperature on the ipsilateral face and contralateral body, dysphagia, dysarthria, and hiccups. Which artery is most likely occluded?

• A Posterior inferior cerebellar artery (PICA) ✓
• B Anterior inferior cerebellar artery (AICA)
• C Basilar artery
• D Posterior cerebral artery

Explanation

This is the classic lateral medullary (Wallenberg) syndrome caused by PICA or vertebral artery occlusion. The key features are ipsilateral Horner syndrome (descending sympathetic fibres in lateral tegmentum), ipsilateral facial pain/temperature loss (spinal trigeminal nucleus), contralateral body pain/temperature loss (spinothalamic tract), and dysphagia/dysarthria (nucleus ambiguus). AICA affects the lateral inferior pons (causing ipsilateral deafness), and PCA affects the occipital cortex causing visual field defects.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.