It is one of the most complex neurovascular syndromes and serves to repeat the basic neuroanatomical structure of the brainstem. A current patient with embolic vertebral artery occlusion helps us to demonstrate the unique features. I won’t go into the details here, but mention a few things:
- If it is just the brainstem there may or may not be cerebellar signs (depending on how much the spinocerebellar tract is involved)
- If it is big enough (as in our patient) and reaches to the front, there may be some pyramidal tract signs.
- There is often (always, really) some facial neuropathic pain or itch
- It may lead to sneezing or singultus, 2 neurological fascinating signs that are quite hard to treat.
References: any neuro textbook. Also remember the 4m4s-rule of brainstem anatomy.