A 42-year-old woman, nonalcoholic and nonsmoking, with no history of prior surgical or medical conditions, arrived at the emergency department reporting vomiting, body swaying while walking, speech difficulties, swallowing issues, and facial numbness that persisted for one month. The vomiting episodes were projectile, occurring ten to fifteen times daily, with food particles but no blood. There was no reported history of trauma, falls, headaches, weakness, double vision, abdominal pain, water rash, yellow discoloration of the body or sclera, fever, shortness of breath, fever, loss of consciousness, or episodes of seizures.

Upon arrival at the hospital, the patient appeared pale and unwell, with a pulse of 86 beats/min, regular rhythm, and a blood pressure of 110/60 mm Hg. Her respiratory rate was 22 breaths/min, with oxygen saturation (SpO2) at 96%, and her temperature was 97.2°F. She demonstrated a Glasgow Coma Scale (GCS) score of 15/15 (E4M5V6). Neurological examination revealed scanning speech, nystagmus, exaggerated jaw jerk with deviation to the right (CN V), decreased gag reflex on the right (CN IX, X), reduced tongue power, and inability to protrude the tongue (CN XII), bilateral upper and lower limb power rated at 4/5 except for bilateral knee flexion and extension, which were 5/5. There was decreased pain and temperature sensation in the right upper extremities, impaired bilateral lower extremity joint proprioception, right-sided dysdiadochokinesia, truncal ataxia, and wide-based gait. Cardiac auscultation revealed normal heart sounds without murmurs, and there was no evidence of limb edema on examination. Other systemic examinations did not produce abnormal findings.

All blood tests returned within normal ranges. MRI brain imaging revealed low signal intensity T1(Figure 1) and high signal intensity T2 / FLAIR(Figure 2)in the right lateral aspect of the pons, midbrain, and right middle cerebellar peduncle. This region exhibited restricted diffusion on DWI(Figure 3), with pseudonormalization evident in ADC map images(Figure 4). Additionally, patchy enhancement areas were observed in the peripheral aspect of the lesion. Based on a comprehensive clinical evaluation, physical examinations, laboratory results, and imaging findings, a diagnosis of lateral medullary syndrome was established. Further evaluation of speech and swallowing functions was conducted. The patient underwent conservative management with enoxaparin, aspirin, and atorvastatin. In conjunction with pharmacotherapy, she received speech therapy, swallowing therapy, and physical therapy, resulting in significant improvement. The patient did not experience complications and was discharged after 7 days with instructions for physical rehabilitation. At 90 days of follow-up, she exhibited a favorable functional outcome.