A 62-year-old man suffers an infarct in the territory of the anterior spinal artery at the level of the medulla. Which combination of deficits is expected?
- A Ipsilateral loss of facial pain and temperature with dysphagia and hoarseness
- B Bilateral loss of pain and temperature below the lesion with preserved proprioception
- C Ipsilateral tongue weakness with contralateral hemiplegia and loss of vibration sense ✓
- D Ipsilateral ptosis, miosis and limb ataxia with vertigo
Correct answer: C. Ipsilateral tongue weakness with contralateral hemiplegia and loss of vibration sense
Explanation
This is the medial medullary (Dejerine) syndrome: the anterior spinal artery supplies the pyramid, medial lemniscus and hypoglossal nerve fascicles, giving ipsilateral tongue deviation and contralateral weakness plus loss of vibration and position sense. Options A and D describe the lateral medullary territory supplied by the vertebral or PICA, where the spinal trigeminal nucleus, nucleus ambiguus and sympathetic fibres lie. The medial lemniscus carries vibration and proprioception, killing option B.
Reference: Snell's Clinical Neuroanatomy, 8th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.