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
The features described are suggestive of lateral medullary syndrome(Wallenberg syndrome). Ipsilateral sensory loss over face and contralateral loss of pain and temperature over body. There is no muscle weakness.
Right lateral medullary infarction
Left lateral medullary infarction
Left medial medullary infarction
Right medial medullary infarction