Complete occlusion of vertebral artery and medial medullary infarction

A 70yearold man, who had previous history with hypertension, intracranial dural arteriovenous fistula, and cerebral infarct, developed left hemidysesthesia and left conjugate deviation, and recovered completely within quarterhour. On three days after initial onset, he developed recurrence of these symptoms, neck pain, and vomiting. Neurological findings showed left conjugate deviation, nystagmus, severe hoarseness and dysphagia, mild left hemiplegia, left hemidysesthesia, left bathyhypoesthesia and left hyperalgesia sparing face, and hyperreflexia in bilateral lower limbs. Tongue deviation was not observed. Brain MRA showed right vertebral artery (VA) occlusion and diffusionweighted brain MRI showed hyperintensity in right medial medulla oblongata (Figure 1A,B). Medial medullary infarction