hello welcome to hcm lateral medullary syndrome is a caused by blockage of blood circulation in the one of the brain vessels supplying medulla of brainstem. so nutritional guidelines will not apply here. if the patient has difficulty swallowing due to the stroke he would be suggested accordingly about tube feeding. to prevent such strokes it is essential to see hypertension, diabetes, lipid problems exist. they would need attnetion when it comes to nutrition and not lateral medullary syndrome per se. hope this is helpful.