Lateral Medullary Syndrome

Unbalanced 2

Step 1: View clinicals

A 68 year old man presents with vertigo, dysphagia, dysarthria, and an unbalanced gait for 12 hours; these symptoms were abrupt in onset. His medical and surgical histories are unremarkable. He smokes heavily, but only drinks socially.


Step 2: Order all relevant investigations

Non Contrast CT Brain

The CT scan of the brain appears normal.

ECG

The ECG is significant for Q-waves in leads II, III and AvF. Serial ECGs show no dynamic changes.

MRI Brain

The MRI reveals an infarction of the lateral aspect of the right medulla.

Echocardiogram

The echocardiogram reveals the presence of inferior wall hypokinesis. There are no structural or valvular abnormalities; no cardiac source of emboli is seen. The ejection fraction is 62%.


Step 3: Select appropriate management

Nasogastric Feeding
Speech Therapy
Thrombolysis
Warfarin


Score: ★★☆