A 58-year-old hypertensive man presents with acute 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 on the left. Which artery is most likely involved?

• A Left superior cerebellar artery
• B Left anterior spinal artery
• C Left posterior inferior cerebellar artery ✓
• D Right vertebral artery at the origin

Explanation

The combination of ipsilateral facial sensory loss, contralateral body sensory loss, Horner syndrome, palatal palsy, and ipsilateral ataxia is the lateral medullary (Wallenberg) syndrome, caused by occlusion of the posterior inferior cerebellar artery or a vertebral branch supplying the lateral medulla. The anterior spinal artery supplies the medial medulla, producing contralateral hemiparesis with hypoglossal palsy, which this patient does not have.

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

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Written and medically reviewed by the StethoPrep medical team.