We describe a man with lateral medullary syndrome associated with a long-standing clumsiness of the ipsilateral upper limb. MRI showed that the clinical finding of ipsilateral clumsiness correlated with an extension of the infarction into the dorsal column nuclei but was not reflected in any involvement of the more ventral pyramidal tract. This deficit in movement control that appears superficially like a hemiparesis may result from a combination of lemniscal and spinocerebellar deficits.