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This patient who presents with dysphagia, ataxia, diplopia, nystagmus, hoarseness, ipsilateral facial numbness, and contralateral body numbness most likely has Wallenberg syndrome. This is caused by a stroke in the lateral medulla shown as % in Figure A. Lateral medullary syndrome (also known as Wallenberg syndrome) occurs secondary to occlusion of the posterior inferior cerebellar artery (PICA). The PICA is the primary blood supply to the lateral medulla, which contains the nucleus ambiguus, vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, sympathetic fibers, and the inferior cerebellar peduncle. Disruption of these nuclei results in the characteristic symptoms of Wallenberg syndrome including Horner syndrome, dysphagia, hoarseness, decreased gag reflex, vertigo, ataxia, decreased pain and temperature sensation of the ipsilateral face and contralateral body. Gasca-Gonzalez et al. studied the neurological basis of the symptoms involved in Wallenberg syndrome. They found that understanding the neuroanatomy of the lateral medulla allows for a better understanding of the symptoms in this form of stroke. They recommend that comprehensive mapping of the anatomy is necessary for a proper understanding of Wallenberg syndrome. Figure/Illustration A is a diagram showing regions of the brainstem. Wallenberg syndrome is caused by a lesion of the lateral medulla depicted as %. Incorrect Answers: Answer 2: Answer 3: Answer 4: Answer 5: Bullet Summary: Wallenberg syndrome is caused by a stroke in the lateral medulla.
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