DR. ROSHNI DHOLKAWALA

DR. VIRNA SHAH

Abstract

We present a case of 47 years male, hans chewer and chronic alcoholic with the complaints of sudden onset swaying with numbness of right side of face and binocular diplopia. He had hypertropia of the left eye, skew deviation and horizontal gaze evoked nystagmus. CT Angiogram of the brain showed a right lateral medullary infarct. Blood investigations revealed hyperhomocysteinemia (112.32 micromol/L) and MTHFR mutation. Lateral medullary syndrome (Wallenburg syndrome) is a neurological disorder that occurs as a result of damage to the lateral segment of the medulla. The most common cause is atherothrombotic occlusion of posterior inferior cerebellar artery. Defect in the MTHFR (5 – methyltetrahydrofolate) enzyme will lead to elevated homocysteine levels in blood and predispose to prothrombotic state. Young patients with stroke should be evaluated for hypercoagulable state for exact diagnosis, prompt treatment and to prevent recurrence, given longer life expectancy in these patients