A 45-year-old man presents with loss of pain and temperature on the right side of his face and left side of his body, along with ipsilateral Horner syndrome, hoarseness, and dysphagia. Which artery is most likely occluded?

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

Explanation

This is the classic Wallenberg (lateral medullary) syndrome caused by PICA occlusion. The lateral medullary syndrome involves the spinal trigeminal nucleus (ipsilateral facial pain/temperature loss), spinothalamic tract (contralateral body pain/temperature), nucleus ambiguus (hoarseness, dysphagia), and descending sympathetic fibers (Horner syndrome). AICA occlusion causes a lateral pontine syndrome with additional ipsilateral hearing loss and facial nerve palsy.

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

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Written and medically reviewed by the StethoPrep medical team.