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The anatomy of the cortico-hypoglossal projections and the clinical effect of lesions on them are not clear-cut. Lesions close to the midline of the ventral pons typically impair only the contralateral cortico-hypoglossal projections, while lesions extending to the lateral part of the basal pons, or dorsolateral and mediolateral medulla, affect the ipsilateral projections.1 ,2 This suggests that these fibres decussate close to the pontomedullary junction. However, Chang and Cho3 reported a case of contralateral supranuclear glossoplegia due to an ischaemic lesion on the ventromedial part of the rostral medulla, suggesting the fibres cross caudal to the pontomedullary junction.
We report a case of ischaemic stroke involving the tonsillomedullary segment of the right posterior inferior cerebellar artery that affected …
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