Wallenberg’s syndrome (lateral medullary syndrome)

86 Wallenberg’s syndrome (lateral medullary syndrome)



Instruction


Examine this patient’s cranial nerves.



Salient features



History




• Severe nausea, vomiting, nystagmus (involvement of the lower vestibular nuclei)


• Limb ataxia (involvement of the inferior cerebellar peduncle)


• Intractable hiccups, dysphagia (ninth and tenth cranial nerve involvement).



Examination




• Nystagmus


• Ipsilateral involvement of fifth, sixth, seventh and eighth cranial nerves


• Bulbar palsy: impaired gag, sluggish palatal movements


• Horner syndrome.


Proceed as follows:



• Tell the examiner that you would like to check for the following:


• Cerebellar signs on the same side

• Pain and temperature sensory loss on the opposite side (dissociated sensory loss).

Remember:



• The main features of this syndrome is ipsilateral Horner syndrome and contralateral loss of pain and temperature sensation.


• Wallenberg syndrome is an infarction of the lateral portion of the medullary tegmentum. The most common cause is occlusion of the intracranial vertebral artery.


• Neuroimaging: MRI is preferred because CT provides less complete visualization of the brainstem, owing to artefacts related to the skull. MRI with diffusion-weighted imaging is the most sensitive test available to detect acute infarcts.

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Dec 4, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Wallenberg’s syndrome (lateral medullary syndrome)

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