Presentation
Diabetic and hypertensive patient with a recent history of vertigo and falling to the right side.
Patient Data
There is a focal area of low T1, high T2, FLAIR, and DWI with low signal on ADC (restricted diffusion) involving the right lateral medulla in keeping with a focal infarct.
The MRA shows nearly complete occlusion of the vertebral/basilar arteries.
Chronic small vessel ischemic white matter changes are also at the supratentorial level.
Case Discussion
MRI features are most consistent with a lateral medullary syndrome (LMS) or Wallenberg syndrome which is considered as a clinical syndrome secondary to an acute ischemic infarct involving the lateral medulla oblongata. Most commonly due to an occlusion of the intracranial portion of the vertebral artery followed by PICA and its branches. Hypertension, smoking, and diabetes mellitus are The commonest risk factors (as in this case).
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