A 58-year-old man develops sudden onset of ipsilateral Horner syndrome, ipsilateral facial pain and temperature loss, contralateral body pain and temperature loss, ipsilateral limb ataxia, and hiccups. Which specific structure is infarcted?

• A Medial medullary tegmentum
• B Dorsal pons at the level of abducens nucleus
• C Anterior inferior cerebellar artery territory of the pons
• D Lateral medullary tegmentum (dorsolateral medulla) ✓

Explanation

The constellation of ipsilateral Horner (descending sympathetic fibers), ipsilateral facial pain/temperature loss (spinal trigeminal nucleus/tract), contralateral body hemianalgesia (lateral spinothalamic tract), ipsilateral limb ataxia (inferior cerebellar peduncle), and hiccups (reticular formation) is the classic Wallenberg syndrome caused by lateral medullary infarction, typically due to PICA occlusion. Medial medullary syndrome (Dejerine) causes tongue deviation, contralateral hemiplegia, and proprioception loss. The pons lesions would include facial nerve involvement.

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

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