Acute dysphagia and hoarseness from a rostral medullary infarct

A 62-year-old man is evaluated after developing sudden-onset dysarthria and difficulty swallowing. He also notes that his voice has become hoarse. Neurologic exam shows deviation of the uvula to the right when he says “ah,” and diminished gag reflex on the left. Motor strength in the limbs is normal. MRI demonstrates a small ischemic lesion in the left rostral medulla involving a branch of the posterior inferior cerebellar artery (PICA). Which of the following nuclei is most likely damaged?

(Assume all findings are due to a single focal brainstem lesion.)

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Acute dysphagia and hoarseness from a rostral medullary infarct | QWorld.Ai