A 58-year-old hypertensive smoker develops sudden vertigo, dysphagia, and hoarseness. Examination shows loss of pain and temperature sensation over the left face and right limbs, left Horner syndrome, ipsilateral limb ataxia, and no limb weakness. Which arterial territory is infarcted?

• A Left anterior inferior cerebellar artery
• B Left superior cerebellar artery
• C Left vertebral artery territory including the posterolateral medulla ✓
• D Left paramedian branches of the basilar artery

Explanation

The combination of ipsilateral facial sensory loss, contralateral body pain-temperature loss, Horner syndrome, vertigo, dysphagia, and ipsilateral ataxia without weakness is the lateral medullary (Wallenberg) syndrome, from occlusion of the vertebral artery or its branch, the posterior inferior cerebellar artery. The paramedian basilar branches supply the medial medulla, where corticospinal tract involvement would cause ipsilateral weakness. AICA produces lateral pontine signs including facial weakness and deafness.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.