Palatal deviation

When unilateral pharyngeal weakness is present, the midline raphe of the palate will deviate away from the weak side and toward the normal side on phonation or when eliciting the gag reflex.(1,2) This movement is usually dramatic. Minor movements of the uvula and trivial deviations of the midline raphe are not of clinical significance. Unilateral palatal weakness occurs most often in lateral medullary syndrome. Involvement of cranial nerves IX and X by a process involving the lower cranial nerves, e.g., the jugular foramen syndrome, is a less frequent etiology.

This patient had a partial lateral medullary syndrome due to a vertebral artery dissection that caused right palatal weakness and facial sensory loss.

References

1. Campbell WW. DeJong's the neurologic examination, 7th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2013.

2. Campbell WW. Clinical signs in neurology : a compendium. Philadelphia: Wolters Kluwer Health, 2016.