Hitting a Wall: An Ambiguous Case of Wallenberg Syndrome

Pellegrini, James R.; Munshi, Rezwan; Cao, Bohao; Olson, Samuel R.; Cappello, Vincent

doi:10.7759/cureus.16268

Cited by 2 publications

(5 citation statements)

References 9 publications

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“…[15] The overall prognosis of Wallenberg syndrome is also better than most other acute ischemic infarcts. [6] In addition to the classic dorsolateral medullary syndrome and the eight-and-a-half syndromes, we should also pay attention to the superimposed brainstem syndrome and its variants which are easy to miss due to the need for detailed cranial nerve examination, such as oculomotor examination. [4,16] Therefore, it is important to recognize the features of the classical brainstem syndrome and the eight-and-a-half syndromes in order to localize the lesion and determine the appropriate treatment plan.…”

Section: Discussionmentioning

confidence: 99%

“…[ 5 ] The pathogenesis of dorsolateral medullary syndrome is presumed to be large vessel infarction (50%), followed by arterial entrapment (15%), small vessel infarction (13%), and cardiac embolism (5%). [ 6 ] This patient is a middle-aged male with many years of previous risk factors for hypertension and diabetes mellitus and transcranial Doppler ultrasound foam test showed positive foam test – supports right-to-left shunt (intrinsic type, massive shunt). Therefore, this patient belongs to the cardiogenic embolic type in very rare cause and has multiple lacunar infarcts with a clear etiology.…”

Section: Discussionmentioning

confidence: 99%

“…The dorsolateral medullary syndrome may also present with uncommon clinical symptoms such as hiccup, tongue deviation to the contralateral side of the lesion, and ipsilateral hypotonia of the arm. [ 6 ] It is believed that the diagnosis of Wallenberg syndrome requires the following 2 items: a lesion in the medulla oblongata – dysarthria or dysphagia; a lesion in the dorsolateral medulla oblongata – dysesthesia, Horner’s sign, ataxia. According to the diagnostic criteria, this patient had dysarticulation and dysphagia, accompanied by ipsilateral facial, contralateral hemisensory disorders, ipsilateral Horner’s sign, and ipsilateral ataxia, therefore could be diagnosed in combination with cranial MRI.…”

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] The overall prognosis of Wallenberg syndrome is also better than most other acute ischemic infarcts. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

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Case report: Lateral medullary syndrome with eight-and-a-half syndromes

Zuo,

Zhao,

Zhao

et al. 2024

Medicine

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Rationale: Lateral medullary syndrome is caused by atherosclerosis or embolism of the vertebral artery and its branches or the posterior inferior cerebellar artery (PICA).The eight-and-a-half syndrome is a rare pontocerebellar nerve-ocular syndrome presenting as a one-and-a-half syndrome plus ipsilateral seventh cerebral nerve palsy. The dorsolateral medullary syndrome combined with the eight-and-a-half syndromes is even rarer, so it is important to recognize the features of the classical brainstem syndrome and the eight-and-a-half syndromes. Patient concerns: Most patients with dorsolateral medullary syndrome combined with eight-and-a-half syndromes have a good prognosis, with recovery occurring within a few weeks to a few months, although a few patients may take longer to recover. Diagnosis interventions: In the course of disease development, the patient developed dysarthria, dysphagia, hypothermia, ipsilateral Horner sign and ataxia. Computed tomography was performed which showed cerebral infarction in the left brainstem. Cranial diffusion-weighted imaging + magnetic resonance angiography showed acute infarction in the left cerebellar hemisphere, with a high probability of severe stenosis or occlusion in the intracranial and proximal segments of the basilar arteries. This supports the diagnosis of dorsolateral medullary syndrome. The patient’s limited adduction and abduction of the left eye and limited adduction of the right eye, combined with peripheral paralysis of the affected lateral nerve, supported the diagnosis of eight-and-a-half syndromes. The administration of antiplatelet and anti-ester fixation treatment can effectively improve the symptoms and shorten the course of the disease. Outcomes: After antiplatelet and anti-ester fixation treatment, the symptoms improved and the patient was discharged. Lessons: Dorsolateral medullary syndrome combined with eight-and-a-half syndromes is a rare clinical condition, and therefore more attention should be paid to the early diagnosis and treatment of such patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…[ 15 ] The overall prognosis of Wallenberg syndrome is also better than most other acute ischemic infarcts. [ 6 ]…”

Section: Discussionmentioning

confidence: 99%

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Case report: Lateral medullary syndrome with eight-and-a-half syndromes

Zuo,

Zhao,

Zhao

et al. 2024

Medicine

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“…The most frequent complaints were dizziness, swinging, vertigo, nystagmus, hoarseness, and dysphagia. 3,9,19 Kumral et al stated that an increase in NIHSS at admission and the amount of bleeding can be an outcome predictor in patients with hemorrhage in the medulla oblongata. Increased NIHSS can predict the worsening of neurological deficits.…”

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Wallenberg Syndrome Accompanied by Horner Syndrome at Young Age

Imran

Fadhila²

2023

AKSONA

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Highlight: Wallenberg syndrome caused by medulla oblongata hemorrhage with good functional outcome. Wallenberg syndrome is accompanied by Horner's syndrome, which occurs at a young age. In patients with Wallenberg syndrom, conservative management and medical rehabilitation are used. ABSTRACT Introduction: Wallenberg syndrome is a rare syndrome involving the medulla oblongata, an uncommon hemorrhage site. It is also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome. Wallenberg syndrome has several symptoms that can be divided into vestibulo-cerebellar, bulbar, autonomic, sensory, and atypical. Case: A 27-year-old man came to the emergency unit complaining of dizziness and swinging, as well as a left eyelid that did not open completely, a lack of sweat on the left side of the face, a hoarse voice, swallowing disturbances, hiccups, decreased hearing in the left ear, and a lack of sensation on the left side of the face and the right side of the body. The patient tended to fall to the left and was unsteady when standing. Physical examination revealed Horner syndrome, bidirectional nystagmus, left dysdiadochokinesia, and left ataxia. A CT scan of the head showed a left-sided medulla oblongata hemorrhage. The patient was given conservative therapy, feeding through a nasogastric tube, and medical rehabilitation. A repeat CT scan of the head was done one week later, and it was discovered that the hemorrhage in the medulla oblongata had begun to absorb. Conclusion: Wallenberg syndrome, with a manifestation of hemorrhagic stroke in the medulla oblongata, can occur at a young age with various clinical symptoms. The diagnosis of Wallenberg syndrome is made based on clinical symptoms and imaging findings. Conservative therapy using medicines and medical rehabilitation can provide a speedy recovery. An incorrect diagnosis is a major hazard to patient safety and can have serious consequences, including permanent disability or death.

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Hitting a Wall: An Ambiguous Case of Wallenberg Syndrome

Cited by 2 publications

References 9 publications

Case report: Lateral medullary syndrome with eight-and-a-half syndromes

Case report: Lateral medullary syndrome with eight-and-a-half syndromes

Hemorrhagic Wallenberg Syndrome Accompanied by Horner Syndrome at Young Age

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