A patient presents to the ED with an apparent acute stroke, manifested by hemiparesis. On further exam, a ptosis and miosis are noted contralateral to the weakness. What diagnosis is suggested?
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Lateral medullary syndrome involving the reticulospinal tract, aka Wallenberg with Horner’s.
Wallenberg’s syndrome (CVA involving posterior inferior cerebellar artery) is suggested. The patient classically would have pain and temperature loss contralateral to the ptosis and miosis, although hemiparesis in this distribution is possible as well.
lacunar stroke with brain stem involvement, upper and lower halves of the brain stem, causing a horner’s syndrome with contralateral hemiparesis
lateral medullary syndrome
Wallenberg syndrome (i.e. brainstem infarct.)
vertebral artery dissection
Brown-Sequard syndrome
Weber’s Syndrome
Suggests a CVA at the midbrain level to affect ipsilateral cranial nerve 3 and the cortical symptoms of contralateral hemiparesis
This picture could represent a case of an internal carotid artery occlusion with a horners syndrome on the side without hemiparesis. The hemiparesis is probably due to sympathetic disruption along the carotid artery. Although there should be collateral supply from the circle of willis the possibility cannot be excluded depending on how much occlusion is present. There could be other causes leading to these symptoms one including trauma to the neck disrupting sympathetics by nerve damage
The ptosis + miosis suggests a concurrent Horner’s syndrome. This could be a Carotid Artery Dissection.
Carotid artery dissection
Question 2.2 Weber’s syndrome or superior alternating hemiplegia. PCA Stroke.