Vertebral Artery Occlusion with Ipsilateral Weakness due to Ischemic Stroke at the Medulla–Cervical Spinal Cord Junction: A Case ReportPeter Felton 1; Yugant Khand 2; Ram Saha 1Department of Neurology, Virginia Commonwealth University, Richmond, Virginia 23298-0599, USA.Nepalese Army Institute of Health Sciences - College of Medicine, Sanobharyang, Kathmandu, 44600 Nepal.AbstractPosterior circulation strokes can present with diverse neurological deficits, some of which challenge conventional localization principles. We report a case of a 74-year-old male with a history of prior right medullary infarct who presented with recurrent symptoms and was found to have a new medullary acute ischemic stroke in the setting of chronic right vertebral artery occlusion. Notably, the patient exhibited ipsilateral limb weakness, a finding attributable to involvement near the pyramidal decussation at the medulla–spinal cord junction. This case underscores the importance of detailed neuroanatomical understanding in vertebrobasilar ischemia and highlights the diagnostic complexity of brainstem strokes.