Lateral medullary infarction presenting contralateral palatal paresis.

Palatopharyngeal paresis has never been reported to be contralateral in the lateral medullary infarction (LMI). A 65-year-old lady with acute dorsolateral infarction in the left medulla presented mild hoarseness, mild dysphagia, mild gait ataxia along with marked hypalgesia and thermal anesthesia on the right limbs. To our surprise, palatal weakness was on the right side, instead of being on the left side as expected in typical Wallenberg syndrome. The palatal paresis was noted during voluntary phonation but turned into normal movement while gag reflex was induced. An involvement of corticobulbar fibers before synapsing into the ipsilateral caudal medulla or a selective involvement of the peri-ambigual reticular formation and/or its post-synaptic connection fiber destined to the contralateral swallowing center presumably underlies such a rare contralateral palatal paresis.