Wallenberg's Lateral Medullary Syndrome

Sacco, Ralph L.; Freddo, Lorenza; Bello, Jacqueline A.; Odel, Jeffrey G.; Onesti, Stephen T.; Mohr, J. P.

doi:10.1001/archneur.1993.00540060049016

Cited by 218 publications

(36 citation statements)

References 24 publications

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“…In the previous studies, 9% [11] and 21% [12] of the patients with LMI were reported to accompany cerebellar infarcts, and MRI was used in 67 and 100% of these patients respectively. The relatively high proportion of LMI-plus in our series may be attributed to (1) the inclusion of patients with extra-cerebellar lesions and (2) our use of DWI that can reliably locate acute small infarcts in the posterior circulation territory [13].…”

Section: Discussionmentioning

confidence: 99%

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

et al. 2018

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Background: Lateral medullary infarction (LMI) is not an uncommon disease. Although lesions are usually restricted to the lateral medullary area, some patients have additional infarcts in other parts of the brain. The clinical features and prognosis of isolated LMI (pure LMI, LMIpr) have been investigated. However, it remains unclear whether clinical characteristics, prognosis and factors associated with prognosis differ between patients with LMIpr and those with additional lesions (LMI plus, LMIpl). Methods: Patients with LMI identified by MRI were enrolled. The demographic and clinical characteristics, in-hospital outcome (intensive care unit [ICU] admission, pneumonia and modified Rankin scale [mRS] at discharge), and long-term residual symptoms (vertigo/dizziness, sensory disturbances, dysphagia) and outcomes (occurrence of stroke, acute coronary syndrome [ACS], death, and mRS at follow-up) were compared between LMIpr and LMIpl patients. Factors associated with poor functional outcome (mRS 2–6) at the follow-up were analyzed. Results: Among 248 LMI patients, 161 (64.9%) had LMIpr and 87 (35.1%) had LMIpl. During admission, patients with LMIpl more frequently experienced ICU care, pneumonia and had a higher discharge mRS (3 vs. 2; p < 0.001) than LMIpr patients. The occurrence of stroke, ACS, frequency of death and functional outcome was not different during follow-up. However, residual neurologic symptoms such as dizziness (p = 0.002), dysphagia (p = 0.04) and sensory symptoms (p < 0.001) were more frequent in LMIpr than in LMIpl patients. In LMIpr patients, the rostral location of LMI was associated with poor functional outcome (p = 0.041), whereas in LMIpl patients, the presence of medial posterior-inferior cerebellar artery lesion was associated with good functional outcome (p = 0.030). Conclusion: Although the short-term outcome is poorer in LMIpl than LMIpr patients, long-term residual symptoms are more common in LMIpr patients. The location of the LMI and extra-medullary lesion affects the long-term functional outcome of LMIpr and LMIpl patients respectively.

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Section: Discussionmentioning

confidence: 99%

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

et al. 2018

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“…The "0-2 interval" is a time variable that indicates the upward movement of the larynx plus the relocation time during the pharyngeal phase of swallowing. 13 (2) Because the submental muscles are laryngeal elevators, the SM-EMG is thought to provide information about the onset and duration of the oropharyngeal phase of swallowing within the period referred to as the "A-C interval." 13 (3) The third parameter, denoted as the "A-0 interval" is the period between the onset of SM-EMG (A) and the appearance of the upward deflection (0) of the laryngeal sensor.…”

Section: Electrophysiological Recording Methodsmentioning

confidence: 99%

“…1,2 Among these symptoms and signs, dysphagia has been reported in 51% to 94% of the patients with WS. 1,2 It has been widely accepted that in most cases the dysphagia in WS is initially severe enough to require nonoral feeding but often improves rapidly, and the patient can return to oral feeding within 1 to 2 months after the stroke. 3,4 However, in some patients, dysphagia does not recover for many months, even years.…”

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confidence: 99%

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Aydoğdu

Ertekin

Tarlacı

et al. 2001

Stroke

130

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Background and Purpose-We have investigated the pathophysiological mechanisms of dysphagia in Wallenberg's syndrome (WS) that are due to lateral medullary infarction (LMI). Methods-Twenty patients with WS were evaluated by means of clinical and electrophysiological methods that measured the oropharyngeal phase of voluntarily initiated swallowing. For comparison, 22 patients with unilateral hemispheric infarction were investigated during the acute stage of stroke, and 4 patients with unilateral peripheral 9th and 10th cranial nerve palsies were studied. Age-matched 30 healthy control subjects were also included in the study. Results-It was found that dysphagia was clinically more severe in WS patients than in the patients in the other groups.The pharyngeal phase of swallowing was predominantly impaired, whereas in patients with hemispheric stroke, dysphagia was related only to the delay of triggering of the voluntarily induced swallowing. In WS patients, the swallowing reflex was extremely slow in spite of the unilateral involvement due to LMI, whereas the pharyngeal phase of reflex swallowing remained within normal limits in patients with unilateral hemispheric stroke and patients with unilateral peripheral 9th and 10th cranial nerve palsies. Conclusions-Although in WS the lesion due to LMI is unilateral, its effect on oropharyngeal swallowing is bilateral. In LMI, primarily the premotor neurons in the nucleus ambiguus and their connections seem to be affected. Consequently, a disruption and/or disconnection of their linkage to swallowing-related cranial motor neuron pools bilaterally and to the contralateral nucleus ambiguus could produce the swallowing disorders in WS. However, the remaining intact ipsilateral premotor neurons and the contralateral center in the medulla oblongata may eventually begin to operate and overcome the severity and long-term persistence of dysphagia.

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“…The WS and LMI are easily diagnosed on the basis of the specific neurological findings, but pathological verification may usually be lacking because the LMI is rarely fatal. Although the combinations of the various signs and symptoms are helpful for the clinical diagnosis of WS, the presence of the different signs and symptoms may vary from patient to patient [2] [3].…”

Section: Discussionmentioning

confidence: 99%

“…Clinical symptoms include swallowing difficulty, or dysphagia [1], slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia, and possibly palatal myoclonus [2].…”

Section: Introductionmentioning

confidence: 99%

Case Report on Hiccup and Lateral Medullary Syndrome

Ibrahim¹,

Fadhil²,

Ali³

et al. 2015

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The case study is aimed at providing a more thorough analysis of a case of lateral medullary syndrome presented only with persistent hiccup after eating lunch the study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of lateral medullary syndrome. Ethical committee has approved this case after taking consent from the patient and explaining to him the importance of the case in clinical practice.

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Wallenberg's Lateral Medullary Syndrome

Cited by 218 publications

References 24 publications

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

Lateral Medullary Infarction with or without Extra-Lateral Medullary Lesions: What Is the Difference?

Dysphagia in Lateral Medullary Infarction (Wallenberg’s Syndrome)

Case Report on Hiccup and Lateral Medullary Syndrome

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