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Vertebral artery dissection with lateral medullary (Wallenberg's) syndrome

Case contributed by Mohammad A. ElBeialy
Diagnosis almost certain

Presentation

Status post-traumatic with headache, neck pain, dysarthria, dysphagia, meiosis, ataxia, vertigo and sensory deficits.

Patient Data

Age: 25 years

CT brain is unremarkable. 

A small rounded left posterolateral medullary lesion with restricted diffusion demonstrating high DWI and low ADC signal as well as hyperintense T2 and FLAIR & mildly hypointense T1 signal. 

A few small left cerebellar demyelinating foci with restricted diffusion are noted as well.

Left frontal sinusitis is incidentally noted.

The rest of the study is unremarkable.  

MR angiography shows dissection of the left vertebral artery with an intimal dissection flap and occluded left vertebral artery with lost its signal.   

Case Discussion

Post-traumatic left vertebral artery dissection with left posterolateral medullary infaction (lateral medullary or Wallenberg's syndrome) and small left cerebellar acute infarctions. 

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