A 56 year old man with a history of hypertension complains of nausea, vomiting and unsteadiness for the past 2 days. He then develops left sided loss of facial pain and right sided sensory loss. On examination muscle tone and power is normal, with a normal mental status. There is scew deviation of the eyes,left eye ptosis, and titubation. He also has loss of pain and temperature sensation over right arm and leg and decreased joint position sensation in the left foot and is not able to walk. MRI of the patient might show the following
A 56 year old man with a history of hypertension complains of nausea, vomiting and unsteadiness for the past 2 days. He then develops left sided loss of facial pain and right sided sensory loss. On examination muscle tone and power is normal, with a normal mental status. There is scew deviation of the eyes,left eye ptosis, and titubation. He also has loss of pain and temperature sensation over right arm and leg and decreased joint position sensation in the left foot and is not able to walk. MRI of the patient might show the following
π‘ Explanation
**Core Concept**
The clinical presentation suggests a lesion in the brainstem, specifically the **medulla oblongata** or **pons**, affecting multiple cranial nerves and sensory pathways. The combination of **cranial nerve palsies**, **sensory deficits**, and **ataxia** points towards a localized lesion in the brainstem.
**Why the Correct Answer is Right**
The patient's symptoms, including **skew deviation of the eyes**, **ptosis**, **titubation**, and **crossed sensory deficits** (loss of pain and temperature sensation on one side of the body and decreased joint position sensation on the opposite side), are characteristic of a **lateral medullary syndrome** or **Wallenberg's syndrome**. This syndrome is typically caused by a **vertebral artery occlusion** or **dissection**, leading to infarction of the **lateral medulla**.
**Why Each Wrong Option is Incorrect**
**Option A:** This choice is incorrect because it does not account for the specific pattern of sensory deficits and cranial nerve palsies seen in this patient.
**Option B:** This option is also incorrect as it does not explain the combination of symptoms presented.
**Option C:** Similarly, this choice does not match the clinical presentation.
**Option D:** This option is incorrect as it is not consistent with the patient's symptoms.
**Clinical Pearl / High-Yield Fact**
A key point to remember is that **lateral medullary syndrome** often presents with **crossed sensory deficits**, where the face is affected on one side and the body on the opposite side, due to the close proximity of sensory tracts in the brainstem.
**Correct Answer:** D. Lateral Medullary Syndrome (Wallenberg's Syndrome)
β Correct Answer: B. Left lateral medullary infarction
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