lateral medullary syndrome
i.e. PICA syndrome (posterior inferior cerebellar artery)
a RARE syndrome let's be real
the classical patient
older vasculopath presenting with acute onset
- dizziness/vertigo
- loss of balance with gait instability (i.e. ataxia)
- hoarse voice/dysarthria
- difficulty swallowing
| territories affected: | inferior cerebellar peduncle, lateral medulla oblongata |
|---|---|
| Etiology | occlusion of PICA or vertebral artery |
| Epidemiology | older vasculopath |
| Clinical presentation: | see lesions cerebellar signs with Horner's syndrome |
| Investigations: |
clinical presentation
| Ipsilateral findings | Contralateral findings |
|---|---|
| Horner's syndrome (ptosis, miosis, anhidrosis) | Spinothalamic loss (pain/temp) in limbs |
| Cerebellar signs, nystagmus | |
| Cranial nerves IX, X palsy (palatal paralysis, loss of taste posterior 1/3 tongue) | |
| Trigeminal spinothalamic loss in the face |
associated with multiple lesions:
- vestibular nuclei
- inferior cerebellar peduncle
- nucleus ambiguus → glossopharyngeal, vagus nerve
- spinothalamic tracts
- spinal trigeminal nucleus and tract
- descending sympathetic tract (ipsilat Horner's syndrome)