Partial Wallenberg Syndrome with Contralateral Bulbar Palsy

Lateral medullary syndrome, also called Wallenberg syndrome, is a brainstem stroke with features like ipsilateral Horner’s syndrome, dysphagia, crossed sensory deficits, vertigo, and ipsilateral ataxia. Incomplete or atypical variants of lateral medullary syndrome may present with selective or crossed neurological deficits, delaying diagnosis. We report a case of a 52-year-old male presenting with dysphagia and right hemisensory impairment. Neurological examination revealed left partial ptosis and miosis, along with an absent gag reflex on the right side. MRI demonstrated an acute infarct at the left lateral pontomedullary junction, consistent with the atypical presentation of lateral medullary syndrome. Treatment with anti-platelet therapy, statins, and swallowing rehabilitation led to significant clinical improvement. This case illustrates the variability in presentations of lateral medullary syndrome and underscores the need to correlate focal neurological findings with neuroimaging for early recognition of atypical medullary infarcts.