A 55-year-old hypertensive smoker suddenly develops vertigo, hoarseness, dysphagia, right facial anhidrosis and ptosis, loss of pain and temperature sensation over the right face, and loss of the same modalities in the left limbs. Limb power is normal. Which artery is involved?

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

Explanation

This is lateral medullary (Wallenberg) syndrome, classically from right posterior inferior cerebellar artery or vertebral artery occlusion affecting the lateral medulla. Crossed pain temperature loss, ipsilateral Horner syndrome, bulbar symptoms, and preserved corticospinal tract function are characteristic. Anterior spinal artery territory gives medial medullary syndrome with ipsilateral hemiparesis and hypoglossal palsy, which distinguishes it clearly here.

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

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Written and medically reviewed by the StethoPrep medical team.