Paroxysmal sneezing due to dorsolateral medulla syndrome

Sneezing is a common and protective reflex because of nasal irritation, while it is not a common symptom in neurological practice. Bilateral vertebral artery dissection (VAD) related to paroxysmal sneezing rarely reported. The association of dorsolateral medulla syndrome (LMS) with sneezing has not been confirmed in humans. There have been reports that paroxysmal sneezing can b e an initial symptom of LMS. In this report, we describe a case to confirm the concept that the paroxysmal sneezing should be interpreted as the cause rather than the initial symptom of LMS, and to indicate that the VAD caused by sneezing is the cause of LMS. •The paroxysmal sneezing should be interpreted as the cause rather than the initial symptom of LMS.•Bilateral vertebral artery dissection (VAD) related to paroxysmal sneezing rarely reported.•Sudden paroxysmal sneezing with acute neurological deficits should indicate the possibility of carotid artery dissection.•Physicians should be alert to paroxysmal sneezing with neurological deficits in order to recognize ischemic stroke early.