Case · Trainee · PICA territory / Wallenberg
Vertigo with crossed sensory findings
59-year-old woman, hypertension, AF on apixaban.
Vignette
A 59-year-old woman with atrial fibrillation presents with acute vertigo, hoarseness, and difficulty swallowing. Examination shows a partial ptosis on the right with a small right pupil. Pin-prick sensation is reduced on the right side of the face and the left side of the body. There is right limb ataxia.
Diagnostic question
Which territory is most likely involved?
Teaching point
Central HINTS plus brainstem signs in the AF patient is stroke until imaged otherwise. Wallenberg syndrome is the classical lateral medullary presentation: Horner + crossed sensory + ipsilateral ataxia + dysphagia / dysphonia, in PICA territory.