Acute bilateral medial medullary infarct with hypoplastic vertebral artery

The patient was a 60-year-old man who had hypertension or ten years and was not on antihypertensive medication. He ad history of transient ischaemic attack 15 years ago. He was a on-smoker and did not drink alcohol. On the day of admission, e presented with sudden onset of “choking sensation” followed y vomiting and slurring of speech. Within an hour, he became rowsy and was not moving the left upper limb and left lower imb. On arrival to casualty, he was noted to have inspiratory strior. His blood pressure was 204/100 mmHg with pulse rate of 5/min (regular). He was afebrile, but was tachypnoeic with oxyen saturation of 97% on high flow mask (with 15 L of oxygen). His apillary blood glucose was 8.5 mmol/L. In view of respiratory disress with stridor, he was intubated and ventilated in intensive care nit. On minimal sedation, he was able to open both eyes sponaneously and was able to obey one step command. There was eft gaze preference with left horizontal nystagmus. There was no symmetry on elevation of soft palate but his gag reflex was weak