A 32 year old woman presents to the emergency department with headache and vomiting. She
was decorating her ceiling that morning when the headache began, felt mainly occipital with
neck pain. Some 2 hours later she felt nauseated, vomited and was unable to walk. She also
noticed that her voice had altered. She takes no regular medications and has no significant past
medical history. Exam: acuity, field and fundi are normal. She has upbeat nystagmus in all
directions of gaze with normal facial muscles and tongue movements. Her uvulas deviated to the right and her speech is slurred. Limb exam: left arm past-pointing and dysdiadochokinesis
with reduced pin prick sensation in her right arm and leg. Although power is normal, she can’t
walk as she feels too unsteady. Where is the most likely site of lesion?
- Right medial medulla
- Left medial pons
- Left cerebellar hemisphere
- Right lateral medulla
- Left lateral medulla
Medicine
The key is e. Left lateral medulla. [ Diagnosis is Lateral Medullary Syndrome. There is a loss of pain
and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of
the face. There is associated cerebellar symptoms and other cranial nerve involvement].
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