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Wallenberg's syndrome; lateral medullary syndrome/infarction

Pathology: - brainstem infarction of the lateral medulla oblongata in the distribution of the posterior inferior cerebellar artery (PICA) Clinical manifestations: 1) central vertigo* 2) nausea/vomiting 3) diplopia 4) alternating hemianesthesia [1], contralateral hemianesthesia [2] 5) pharyngeal & laryngeal paralysis 6) dysphagia 7) hoarseness, dysphonia [1] 8) ipsilateral cerebellar ataxia, dysmetria & dysdiadokokinesia [3] 9) contralateral pain & loss of temperature sensation in extremities [2] 10) ipsilateral Horner's syndrome 11) ipsilateral facial pain & loss of temperature sensation - facial anesthesia [2] 12) ipsilateral lower facial paralysis/paresis [2] 13) nystagmus * alternatively, infarction in the distribution of the PICA may result in isolated central vertigo [2] Differential diagnosis: - cerebellar infarction - facial involvement & involvement in pain & temperature pathways distinguish lateral medullary infarction

Related

posterior inferior cerebellar artery stroke; cerebrovascular accident (CVA)

General

syndrome brainstem infarction

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 662
  2. Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  3. Wikipedia: Lateral Medullary Syndrome http://en.wikipedia.org/wiki/Lateral_medullary_syndrome
  4. NINDS Wallenberg's Syndrome Information Page https://www.ninds.nih.gov/Disorders/All-Disorders/Wallenbergs-Syndrome-Information-Page