Wallenberg's Syndrome

Diagram of the arterial circulation at the base of the brain. Source: Gray's Anatomy, 1918.

Wallenberg syndrome is a neurological condition caused by a stroke in the vertebral or posterior inferior cerebellar artery of the brain stem. Affected individuals may have sensory disturbances, paralysis and difficulties with balance. They may also have difficulty swallowing and vertigo (a sensation of spinning motion).

Other Names

• Lateral medullary syndrome
• Posterior inferior cerebellar artery syndrome

Signs and Symptoms

The most common symptoms include:

• Difficulties with swallowing
• Hoarseness
• Dizziness, nausea and vomiting
• Rapid involuntary movements of the eyes (nystagmus)
• Problems with balance and gait coordination
• Uncontrollable hiccups may also occur.

Some individuals will experience a lack of pain and temperature sensation or sense of taste on only one side of the face, or a pattern of symptoms on opposite sides of the body – such as paralysis or numbness in the right side of the face, with weak or numb limbs on the left side.

The frequency of each symptom, as well as the correlation between symptoms and infarct (area of brain tissue death) seen on Computed tomography (CT) scan or Magnetic resonance imaging (MRI) was evaluated in a 1993 study. ^[1]

Causes

Scheme of roof of fourth ventricle. The arrow is in the foramen of Majendie. The illustration shows the relationship between the medulla and the cerebellum. Source: Gray's Anatomy, 1918.

Wallenberg syndrome is caused by a stroke in one of two arteries of the brain stem.

A stroke is a blood clot in an artery or blood vessel which results in a blockage in blood flow to part of the brain. When blood flow is interrupted, cell death and tissue damage occur. The symptoms of a stroke depend on the location of the blood clot.

The stroke associated with Wallenberg syndrome usually causes damage in the lateral medulla of the brain. It may also cause damage in the cerebellum.

Treatment

There is no specific cure for Wallenberg's syndrome. Treatment is symptomatic.

Medications

In some cases, medication may be used to reduce or eliminate pain. Some doctors report that the anti-epileptic drug gabapentin appears to be an effective medication for individuals with chronic pain.

Baclofen may be effective in treating persistent hiccups associated with the syndrome.

Therapies

A feeding tube may be necessary if swallowing is very difficult.

Speech or swallowing therapy may also be beneficial in some patients.

Expected Outcome

Duration

The outlook for someone with Wallenberg’s syndrome depends upon the size and location of the area of the brain stem damaged by the stroke. Some individuals may see a decrease in their symptoms within weeks or months following treatment. Others may be left with significant neurological disabilities for years after the initial symptoms appeared.

History

Wallenberg syndrome was first described by Gaspard Vieusseux (1746-1814), a Swiss physician who was also the first to describe bacterial meningitis. It was named for Adolf Wallenberg (1862-1949), a German internist and neurologist, who gave a more accurate description of the pathology of the syndrome after an autopsy.

Research

• The case of a patient with ipsilateral (one-sided) shivering after a lateral medullary infarct (stroke) is reported. ^[2]
• A female patient developed Wallenberg syndrome (lateral medullary infarct) after treatment to stimulate ovulation. ^[3]
• The use of Vestibular Evoked Myogenic Potentials (VEMPs) in the assessment of Wallenberg syndrome is discussed. This test is found to be useful for this purpose. ^[4]

References

1. ↑ Sacco RL, Freddo L, Bello JA, Odel JG, Onesti ST, Mohr JP. Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations. Arch Neurol. 1993 Jun;50(6):609-14. Abstract
2. ↑ Gilbert GJ. Unilateral shivering: a result of lateral medullary infarction. South Med J. 2007 May;100(5):540-1.
3. ↑ Lin HC, Chen MJ, Chou CH, Young YH. Lateral medullary syndrome in a woman after ovulation induction. Auris Nasus Larynx. 2007 Sep;34(3):383-5. Epub 2007 Mar 6. Abstract
4. ↑ Deftereos SN, Panagopoulos G, Gryllia M, et al. Neurophysiological monitoring of brainstem function in a patient with Wallenberg syndrome, using Vestibular Evoked Myogenic Potentials. Neurol Neurophysiol Neurosci. 2006 Jun 29:3. Abstract

External Links

National Stroke Association

The Internet Stroke Center