A 58-year-old hypertensive smoker presents with sudden vertigo, hoarseness, and difficulty swallowing. Examination shows loss of pain and temperature sensation over the left face and right limbs, left Horner syndrome, left palatal weakness, and ataxia of the left limbs. Power is normal and deep tendon reflexes are preserved. Which artery is most likely occluded?

• A Left anterior inferior cerebellar artery
• B Left posterior inferior cerebellar artery ✓
• C Left superior cerebellar artery
• D Left anterior spinal artery

Explanation

The combination of ipsilateral facial pain-temperature loss, contralateral limb pain-temperature loss, ipsilateral Horner syndrome, dysphagia, hoarseness, and ipsilateral limb ataxia is the lateral medullary (Wallenberg) syndrome, caused by occlusion of the vertebral artery or its branch, the posterior inferior cerebellar artery. The anterior spinal artery causes medial medullary syndrome with contralateral hemiparesis and hypoglossal palsy, which this patient lacks since power and reflexes are normal.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.