Neurology: lateral medullary syndrome: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Neurology: lateral medullary syndrome

Sample item

A 60-year-old hypertensive man has sudden vertigo, vomiting, hoarseness and dysphagia. Examination shows loss of pain and temperature sensation on the left side of the face and right half of the body, left Horner syndrome and left limb ataxia, with normal limb strength. Which vessel is occluded?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Left posterior inferior cerebellar artery or left vertebral artery

Lateral medullary (Wallenberg) syndrome involves the spinal trigeminal nucleus (ipsilateral facial pain and temperature loss), the spinothalamic tract (contralateral body), nucleus ambiguus (hoarseness, dysphagia), sympathetic fibres (Horner) and the inferior cerebellar peduncle (ataxia). Pyramidal fibres are spared. The usual cause is occlusion of the vertebral or posterior inferior cerebellar artery.

Option by option

  • A. Basilar artery perforating branches

    Basilar perforator occlusion causes pontine weakness and locked-in states, which are absent here.

  • B. Anterior spinal artery supplying the medulla

    Anterior spinal artery occlusion causes medial medullary syndrome with contralateral hemiparesis and tongue deviation.

  • C. Left posterior inferior cerebellar artery or left vertebral artery (correct)

    Correct. The deficits match the territory of the posterior inferior cerebellar or vertebral artery.

  • D. Left anterior inferior cerebellar artery

    AICA occlusion causes a lateral pontine syndrome with facial paralysis and deafness.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Left posterior inferior cerebellar artery or left vertebral artery. Lateral medullary (Wallenberg) syndrome involves the spinal trigeminal nucleus (ipsilateral facial pain and temperature loss), the spinothalamic tract (contralateral body), nucleus ambiguus (hoarseness, dysphagia), sympathetic fibres (Horner) and the inferior cerebellar peduncle (ataxia).

Why is "Basilar artery perforating branches" not the answer?

Basilar perforator occlusion causes pontine weakness and locked-in states, which are absent here.

Why is "Anterior spinal artery supplying the medulla" not the answer?

Anterior spinal artery occlusion causes medial medullary syndrome with contralateral hemiparesis and tongue deviation.

Why is "Left anterior inferior cerebellar artery" not the answer?

AICA occlusion causes a lateral pontine syndrome with facial paralysis and deafness.

What concept does this question test?

It tests Neurology: lateral medullary syndrome in General Medicine. Pyramidal fibres are spared. The usual cause is occlusion of the vertebral or posterior inferior cerebellar artery.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: lateral medullary syndrome?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.