lateral medullary infarction (Wallenberg syndrome)

Wallenberg syndrome is also known as lateral medullary syndrome and posterior inferior cerebellar artery syndrome. This neurological disorder is associated with a variety of symptoms that occur as a result of damage to the lateral segment of the medulla posterior to the inferior olivary nucleus. It is the most common posterior circulation ischemic stroke syndrome

Etiology

Wallenberg syndrome is caused most commonly by atherothrombotic occlusion of the vertebral artery, followed most frequently by the posterior inferior cerebellar artery, and least often, the medullary arteries. Hypertension is the most prevalent risk factor, followed by smoking and diabetes. Cerebral embolism is a less frequent cause of the infarction. The other important cause to remember is vertebral artery dissection, which may have risk factors including neck manipulation or injury, Marfan syndrome, Ehlers Danlos syndrome, and fibromuscular dysplasia. Vertebral artery dissection is the commonest cause of Wallenberg syndrome in younger patients

Epidemiology

It can be estimated that there are more than 60,000 new cases of Wallenberg syndrome each year in the United States.

Presentation suggests right—sided lateral medullary infarction (Wallenberg syndrome)

Vestibulocerebellar  symptoms

• Nystagmus (both horizontal and rotational),
• Vertigo with falling to the side of the lesion, and difficulty sitting upright without support.

Sensory symptoms

• loss of pain and temperature in the ipsilateral face (spinal trigeminal nucleus and tract) and contralateral trunk/limbs (spinothalamic tract).
• Despite the loss of sensation, pain in the face is sometimes prominent, also likely due to spinal trigeminal nucleus and tract lesions.

Ipsilateral bulbar muscle weakness

(eg, dysphagia, dysarthria, hoarseness) due to involvement of the nucleus ambiguus 

Autonomic dysfunction

 (eg, ipsilateral Horner syndrome). The corneal reflex may be diminished due to disruption of the spinal trigeminal nucleus (located within the lateral medulla), which interrupts the reflex pathway.

Treatment / Management

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