Loss of sensation on the left side of the face and the opposite limb...Can you make a decision within 3 seconds after seeing the film?

*For medical professionals to read only for reference 3, 2, 1, and give your answer 42-year-old man, presenting with loss of sensation on the left face and contralateral limb, drooping left eyelid, hoarseness and dizziness
.

Look at the image below, what do you consider the patient’s diagnosis? ---Answer dividing line---Are you sure you want to see the answer? ▌ Image analysis MRI axial FLAIR images (a, b) showed that the signal of the left dorsolateral medulla was abnormally increased
.

The 3D volume rendering CTA image (c) shows that the posterior inferior cerebellar artery on the left is absent, and the proximal part of the posterior inferior cerebellar artery on the right is displayed
.

Although the CTA scan shows the posterior inferior cerebellar artery, conventional angiography can clearly be occluded
.

▌ Imaging diagnosis of dorsolateral medulla syndrome
.

▌ Clinical manifestations A.
The lateral dorsal medulla syndrome is caused by the occlusion of the posterior inferior cerebellar artery and the lateral medulla oblongata infarction
.

Vertebral artery involvement can also have similar manifestations, most of which occur in elderly patients with secondary thromboembolic diseases
.

In young patients, vertebral artery dissection related to trauma or vascular disease is the most common cause
.

B.
Clinically, the patient presents with acute onset of hypothermia in the ipsilateral and contralateral body, ipsilateral Horner sign, ipsilateral limb ataxia and dizziness
.

Hoarseness and dysphagia are often secondary to cranial nerve involvement
.

C.
The clinical symptoms and prognosis are closely related to the size of the infarction, and the prognosis is worse for those with a large infarction
.

However, the prognosis of most patients is relatively good, and the symptoms gradually improve
.

 ▌ Image points A.
The dorsolateral medulla syndrome is usually caused by the occlusion of the posterior inferior cerebellar artery and the dorsolateral medulla oblongata infarction
.

B.
Symptoms include analgesia, Horner’s sign, ataxia, hoarseness, and dizziness
.

C.
MRI scan showed increased signal along the dorsolateral medulla of the T2/FLAIR sequence and limited diffusion (acute phase)
.

D.
Isolated bulbar lesions are small, only seen in the lowest layer of the MRI scan axis
.

References: [1] Kim JS.
Lee JH.
Suh DC, et al.
Spectrum of lateral medullary syndrome.
Correlation between clinical findings and manetic resonance imaging in 33 subjects.
Stroke, 1994, 25: 1405 -1410 More "Daily "Understand an image", you can scan the code to view the medical community strives to be accurate and reliable when the content is reviewed, but it is not about the timeliness of the published content, and the accuracy and completeness of the cited information (if any), etc.
Make any promises and guarantees, and assume no responsibility for the outdated content and the possible inaccuracy or incompleteness of the cited information
.

Relevant parties are requested to check separately when adopting or using this as a basis for decision-making
.

Contribution/Reprint/Business Cooperation: yxjsjbx@yxj.
org.
cn