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submitted by moloko270(31),

this is Wallenberg syndrome - stroke caused by obstruction of PICA - so thats why we get symptoms of dysphagia, hoarseness, absent gag reflex (p. 502 FA)

armymed88  dysphagia from hit of nucleus ambiguus (CN IX/X/XI) Sensation changes due to hit of lateral spinothalamic tract and spinal trigeminal Check out rule of 4s if you haven't already +  
theecohummer  Yup, lateral meduallary syndrome or Wallenburg Syndrome. Whatever you want to call it. The hemifacial analgesia is from damage to the spinal trigeminal nucleus/tract, and you get the hoarseness from damage to the vagus and the body loss is from the spinal thalamic tract. You can also get Horner’s syndrome with this. +1  
dr.xx  Lateral medullary syndrome = Wallenberg's syndrome +  


submitted by magrufnis(0),

I’m confused about this one. Weakness of extension and pronation of the right forearm, with a decreased triceps muscle stretch reflex. The answer was C7 nerve root, but how are you able to localize to C7 and not C6 or C8? I figured that extension is radial, C5-T1, and pronation is median, also C5-T1. Triceps reflex is C7-C8 (FA2019 says C6-C7). How would you narrow down to just C7 damage?

txallymcbeal  My FA2018 has “C7” bolded, meaning it is the main nerve root. But I also got this one wrong so I can’t be much help besides that. +  
mnemonia  Honestly just a guess but I have this vague understanding that intrinsic hand muscles are C8-T1 so we might’ve expected more hand motor findings as well with a C8 lesion. +1  
theecohummer  I narrowed it down to C7 using the fact that the C7 myotome is elbow extension. I also learned that the C7 nerve root was the main contributor to the triceps DTR so I just went with that. +  
mchu21  They also mentioned that the person had weakness pronating the right forearm which is performed by the biceps. Biceps is innervated by the musculocutaneous nerve which is C5-C7 and that's what helped me pick C7 > C8. +  
mcl  Sorry, I thought the biceps was a supinator of the forearm? +1  
henoch280  yes.. its the supinator not pronator +