Diminished Gag Reflex And Loss Of Pain And Temperature Over The Left Face

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Question #19 A 79-year-old woman is brought to the emergency department because of a l-hour history of hoarseness. Her pulse is 85/min and blood pressure is 142/90 mm Hg. Physical examination shows a diminished gag reflex and loss of pain and temperature over the left face and right trunk and extremities. There is no facial asymmetry and the tongue does not deviate when protruded. Her strength is 5/5 bilaterally in both the upper and lower extremities. Ophthalmologic examination shows involuntary, rhythmic ocular movements. There is left-sided miosis and ptosis. This patient’s condition is most likely caused by occlusion of which of the following vessels?


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