Ipsilateral lacrimation and rhinorrhea associated with postural change in lateral medullary infarction: a case report

Abstract Background Lateral medullary infarction (LMI) is a posterior-circulation ischemic stroke involving the lateral or dorsolateral medulla, most commonly associated with vertebral artery or posterior inferior cerebellar artery disease. Its heterogeneous clinical manifestations reflect variable involvement of sensory, vestibular, bulbar, and autonomic pathways within the medulla. Case presentation We report ipsilateral lacrimation and visible anterior rhinorrhea showing an apparent association with postural change, notably in the absence of pain symptoms such as headache. While classic autonomic features such as Horner’s syndrome are well‑recognized in LMI, this specific constellation of position‑related lacrimation and rhinorrhea in the absence of pain appears to be rarely reported in the literature. Discussion The temporal association between the infarction and the secretomotor symptoms raises the possibility of transient dysfunction within medullary autonomic networks. However, direct involvement of the nucleus tractus solitarius or a specific sympathetic–parasympathetic pathway was not demonstrated, and the proposed mechanism remains hypothetical. Conclusion This case underscores the necessity of considering individual anatomical differences in clinical assessment and highlights autonomic dysfunction as a distinct feature of lateral medullary infarction. Recognition of such atypical autonomic presentations may facilitate earlier diagnosis and differentiation from conditions such as trigeminal autonomic cephalalgias, thereby contributing to improved clinical decision-making in posterior circulation stroke. The reporting of this study conforms to CARE guidelines.