When ischemia of lateral medulla occurs it manifests as lateral medullary syndrome. Medulla is a part of brainstem. It controls many autonomic functions. The ischemia is mostly the result of thrombosis of vertebral artery or posterior inferior cerebellar artery. It is also called the PICA syndrome. The syndrome presents in motor and sensory deficit. Sensory deficit of opposite side of trunk and limbs occurs. Sensory deficit of ipsilateral skin of face with loss of temperature and pain. There is dysphagia, slurred speech, vertigo, Hornor's syndrome and palatal myoclonus. The condition is seen in hypertensive patients, history of trauma, underlying collagen vascular diseases and people prone to atherosclerotic occlusions of vessels.