Lateral Medullary Syndrome with Cerebellar Infarct in a Young Hypertensive Diabetic Patient with Bilateral Otomastoiditis: A Rare Case Report

Abstract

Background: Lateral medullary syndrome (LMS) is a rare posterior circulation stroke that can present with diverse neurological symptoms, making diagnosis challenging. Its occurrence in young adults with combined metabolic and infectious comorbidities is uncommon. Case Presentation: A 35-year-old female with uncontrolled type 2 diabetes mellitus and hypertension presented with acute-onset giddiness, vomiting, palpitations, and cough for two days. She denied fever, trauma, seizure, loss of consciousness, or neck stiffness. On examination, she was alert, oriented, hypertensive (BP 172/106 mmHg), and had a pulse rate of 88/min. Neurological assessment revealed left upper eyelid ptosis, horizontal nystagmus, and left-sided gait ataxia without limb weakness or sensory deficits. ENT evaluation showed bilateral mastoid tenderness, and otoscopic examination confirmed bilateral otomastoiditis. CT brain revealed subtle hypodensity in the left cerebellar hemisphere and bilateral otomastoiditis. MRI with MR angiography demonstrated acute infarcts in the left cerebellar hemisphere and left lateral medulla, with poor visualization of the left vertebral artery, confirming LMS due to posterior circulation ischemic stroke. She was treated with dual antiplatelet therapy, antihypertensives, insulin, and empirical antibiotics. Supportive physiotherapy and fall precautions were recommended. Regular medication adherence and symptom monitoring were emphasized to prevent recurrence. Conclusion: This case highlights the importance of considering posterior circulation stroke in young adults presenting with atypical vestibular or cerebellar symptoms, particularly in the presence of metabolic and infectious risk factors. Early imaging and multidisciplinary care can lead to favorable outcomes.