Abstract
A 14-year-old boy presented with vomiting, slurred speech, and leaning rightward. Examination showed dysarthria, right-sided miosis, ptosis, and gaze preference, decreased sensation over the right V2/V3 region and left shin, right lower facial palsy, rightward tongue deviation, and right-sided dysmetria. Neuroimaging revealed brainstem stroke with vertebral artery dissection (figures 1 and 2). The patient's gaze preference exemplifies ipsipulsion, an often forgotten sign of lateral medullary syndrome resulting from damage to contralateral olivocerebellar pathways that decussate in the medulla.1 His ipsilateral facial weakness is due to facial nerve fibers that loop caudally into the medulla and exit at the pontomedullary junction.2
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