A 58-year-old hypertensive man develops sudden onset of ipsilateral Horner syndrome, hoarseness, dysphagia, loss of pain and temperature on the ipsilateral face and contralateral body, and ipsilateral limb ataxia. Which specific arterial territory is occluded?

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

Explanation

The constellation of findings — ipsilateral Horner syndrome (descending sympathetic tract), hoarseness and dysphagia (nucleus ambiguus), ipsilateral facial pain-temperature loss (spinal trigeminal nucleus), contralateral body pain-temperature loss (spinothalamic tract), and ipsilateral limb ataxia (inferior cerebellar peduncle) — defines Wallenberg (lateral medullary) syndrome. This is caused by PICA occlusion. AICA infarction causes a similar but more lateral inferior pontine syndrome with ipsilateral facial nerve palsy and hearing loss.

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

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Written and medically reviewed by the StethoPrep medical team.