Background: Avellis' syndrome (lateral medulla oblongata ischaemia) is a rare neurological disorder. Early recognition of brain stem infarction may prevent referral to specialists other than a neurologist.
Case description: A 53-year-old woman was initially presented to an internist with acute onset of headache, dysphagia, nausea and vomiting. She was also hoarse and had a tingling feeling on the left side of her face, and in her left arm and leg. A neurologist was consulted and diagnosed Avellis' syndrome. MRI of the brain revealed ischaemia in the lateral medulla oblongata on the right side.
Conclusion: Brain stem infarction may be hard to recognize as lateralization is often less predominant than in hemispheric syndromes. In acute onset of dysphagia, the differential diagnosis should always include brain stem infarction.