Utility of thermographic measurements of laterality of body surface temperature to prevent misdiagnosis of acute Wallenberg's syndrome

Abstract

IntroductionAcute Wallenberg's syndrome (WS) is sometimes misdiagnosed as a nonstroke disease including auditory vertigo, and careful neurological examination is required for a precise diagnosis. Lateral difference of body surface temperature (BST) had been reported as a symptom of WS, although further details of this symptom are currently lacking. Our aim was to investigate the laterality of BST of patients with acute WS using thermography and the usefulness of thermography to detect acute WS.MethodsNine consecutive patients with new‐onset acute WS and nine patients with acute pontine infarction, intended for a comparison, were enrolled. Using thermography, the BST of patients was measured and initially evaluated visually. Detailed BSTs were measured using dedicated software. We examined the relationship between BST and other clinical factors, including first diagnosis, clinical symptoms, and MRI findings.ResultsFour patients with WS (44.44%) were misdiagnosed with nonstroke disease and did not receive a thermography assessment at their first visit; in contrast, all acute pontine infarction patients were diagnosed with brain infarction. Eight patients with WS (89%) showed a laterality of BST at multiple sites, and three of eight patients showed a whole‐body laterality of BST; in contrast, only two pontine infarction patients showed laterality of BST at one or two sites. These lateral BST differences were easily observed visually using thermography within two minutes. The BST laterality gradually decreased over time in almost all patients with WS. The infarction size in the WS patients with whole‐body laterality of BST was craniocaudally larger than in the other patients, and the size was smallest in the patient showing no BST laterality.ConclusionsIn contrast to acute pontine infarction patients, almost all patients with acute WS showed lateral BST differences, which was easily detected with thermography. Thermography may thus be a useful tool to prevent misdiagnosis of acute WS.

Laterality of Skin Temperature and Magnetic Resonance Imaging in Patients with Wallenberg Syndrome

“…Thermographic scan was performed at the same time points in all patients. As the laterality of BST decreased with residual sensory symptoms and time, 5,12 this study could provide more clinically important information.…”

“…However, one study suggests that the cause of lateralized BST in patients with WS is a disruption of the connecting pathway of sweating and skin blood flow descending from the lateral brainstem, including the ventrolateral medulla. 5 Disrupted sweating and vasoconstrictive function are likely to increase the BST in the ipsilateral to the infarction in patients with WS. Another study showed that lateralized BST in patients with WS is probably caused by damage to the medullary vasomotor centers.…”

“…Laterality was defined as significant when the BST was macroscopically different, and the discrepancy was more than 0.5°C between the right and left sides. 5 An experienced researcher performed all BST measurements, and throughout the trial, the researcher was blinded to the clinical symptoms of the patients.…”

“…2,3 Recently, the lateral difference in body surface temperature (BST) has been reported as a symptom of WS, resulting from disturbances of the sympathetic nerve pathway. 4,5 We have previously reported the laterality of skin temperature depending on sensory symptoms in patients with WS. 6,7 Our study showed that patients with sensory dysfunction in WS had lateral BST differences, which were detected by infrared thermography.…”

Florid Autonomic Features Associated with Medullary Lacunar Stroke

“…Thermography was found to be a useful tool to differentiate between pontine infarction and Wallenberg's syndrome using the body service temperature [13].…”