Lateral medullary (Wallenberg) syndrome
Sudden onset of ataxia, vertigo and difficulty with swallowing. Previously very fit
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A small focus of restricte ddiffusion in the right postero-lateral medulla, with absent flow void in the adjacent right PICA. TOF MRA shows absent flow/occlusion in the distal right vertebral artery and right PICA.
Findings in this syndrome are usually subtle on MRI (most useful is DWI). Look for PICA or vertebral artery occlusion on the MRA and always consider spontaneous or traumatic vertebral artery dissection.