Fig. 11
From: A radiologic review of hoarse voice from anatomic and neurologic perspectives
Lateral medullary infarction. A 33-year-old woman with history of migraines presenting with acute onset vertigo, nausea, weak voice/swallow, and left extremity sensorimotor deficits after chiropractic manipulation. Diffusion-weighted MRI (a) reveals numerous acute embolic infarctions involving the bilateral cerebellar hemispheres and bilateral thalami, with notable involvement of the left PICA territory including the left lateral medulla (black arrowhead). TOF MRA MIP image (b) reveals absence of flow related enhancement within the left V4 segment and PICA (white arrowhead). Axial TOF image (c) reveals small caliber flow within the residual true lumen (white arrow), with surrounding crescentic lower signal in the false lumen. This constellation of findings is consistent with left vertebral artery dissection with showering of emboli resulting in infarction