A Case of Lateral Medullary Infraction Presenting with Thoracic Sensory Level

ABSTRACT

Loss of pain and temperature sensation due to lateral medullary infarction are well known and classically involve the ipsilateral side of the face and the lower part of the body on the controlateral side. This pattern of sensory loss below a certain level on the trunk, usually a sign of spinal cord disease, may also appear following a lesion in the lateral medullar, due to damage to the spinothalamic tract. A 72-year-old hypertensive man developed sudden dizziness, headache, and gait ataxia. On neurologic examination, he had left limb and gait ataxia. Five days later he noted loss of pain and temperature sensation on the right leg and trunk with a sensory level at T4 with preservation of touch, vibration, and joint position sense in all limbs. Brain MRI showed a small infarct in the left lower lateral medulla. Brain MR angiography showed stenosis of the right proximal carotid artery, left distal vertebral artery, and mid-basilar artery. We report a case of sensory defects with a sensory level on the trunk that occured as the result of lesion of the lower lateral medulla.