Brainstem lesions and clinical correlationsDownloads

A 59-year-old woman with a past medical history of atrial fibrillation currently on warfarin presents to the emergency department for acute onset dizziness. She was watching TV in the living room when she suddenly felt the room spin around her as she was getting up to go to the bathroom. She denies any fever, weight loss, chest pain, palpitations, shortness of breath, lightheadedness, or pain but reports difficulty walking and hiccups. A physical examination is significant for rotary nystagmus and decreased pin prick sensation on the left side of her body. A magnetic resonance image (MRI) of the head is obtained and shows ischemic changes of the right lateral medulla. What other symptoms would you expect to find in this patient?

A 25-year-old man presents to the emergency department with the sudden onset of neck pain and a severe spinning sensation for the last 6 hours. The symptoms initially began while he was lifting weights in the gym. He feels the room is spinning continuously, and he is unable to open his eyes or maintain his balance. The dizziness and pain are associated with nausea and vomiting. Past medical history is unremarkable. His blood pressure is 124/88 mm Hg, the heart rate is 84/min, the temperature is 37.0°C (98.6°F), the respiratory rate is 12/min, and the BMI is 21.6 kg/m2. On physical examination, he is awake and oriented to person, place, and time. Higher mental functions are intact. There are several horizontal beats of involuntary oscillatory eye movements on the left lateral gaze. He has difficulty performing repetitive pronation and supination movements on the left side. Electrocardiogram reveals normal sinus rhythm. Which of the following additional clinical features would you expect to be present?