From the Guidelines
Wallenberg syndrome, also known as lateral medullary syndrome, is a neurological condition caused by a stroke in the lateral part of the medulla oblongata in the brainstem, characterized by a distinct set of symptoms including difficulty swallowing, hoarseness, vertigo, and numbness, and is typically evaluated according to the ACR Appropriateness Criteria topic on “Cerebrovascular Diseases-Stroke and Stroke-Related Conditions” 1.
Clinical Presentation
The condition typically results from blockage of the posterior inferior cerebellar artery (PICA) or vertebral artery, leading to damage to various brainstem nuclei and tracts, including the spinothalamic tract, nucleus ambiguus, and descending sympathetic fibers. Patients present with a characteristic set of symptoms, including:
- Difficulty swallowing (dysphagia)
- Hoarseness
- Vertigo
- Nystagmus
- Ipsilateral facial numbness
- Contralateral body numbness
- Ipsilateral Horner's syndrome (ptosis, miosis, and anhidrosis)
- Ipsilateral ataxia
Diagnosis and Management
Diagnosis involves evaluating patients with abnormal neurologic examination according to the ACR Appropriateness Criteria topic on “Cerebrovascular Diseases-Stroke and Stroke-Related Conditions” 1. The HINTS tool can be useful in screening for stroke, but its accuracy may be dependent on the examiner’s experience 1. Treatment primarily focuses on managing the acute stroke with standard stroke protocols, including possible thrombolysis with tPA if diagnosed within the appropriate time window. Long-term management involves secondary stroke prevention with antiplatelet therapy, blood pressure control, cholesterol management, and lifestyle modifications. Rehabilitation is crucial and should include speech therapy for dysphagia, physical therapy for ataxia, and occupational therapy as needed.
Key Considerations
It is essential to note that the age, blood pressure, clinical features, duration, and diabetes (ABCD2) score is a clinical stroke risk score that can help differentiate strokes from mimics 1. However, the accuracy of HINTS may be limited when used in isolation by emergency physicians, and brain imaging may still be necessary to exclude a stroke in patients presenting with acute vestibular syndrome (AVS) 1.
From the Research
Definition and Symptoms of Wallenberg Syndrome
- Wallenberg syndrome, also known as Lateral Medullary Syndrome, is a condition characterized by a set of symptoms resulting from a stroke in the lateral part of the medulla oblongata in the brainstem 2.
- The symptoms of Wallenberg syndrome can include acute-onset dizziness, visual disturbances, continuous vomiting, difficulty walking, and an altered level of consciousness 2.
Causes and Risk Factors
- Wallenberg syndrome can be caused by a basilar artery thrombosis, which affects both vertebral branches and displays characteristic features associated with the syndrome 2.
- Uncontrolled hypertension is a significant risk factor for developing Wallenberg syndrome, as it can lead to cerebrovascular diseases and increase the risk of stroke 2.
Diagnosis and Treatment
- Diagnosis of Wallenberg syndrome involves a comprehensive assessment incorporating clinical, laboratory, and imaging techniques, including MRI and MRA examinations of the endocranium 2.
- Treatment of Wallenberg syndrome typically focuses on addressing the underlying cause of the stroke and managing the symptoms, which may involve antihypertensive, anticoagulant, or antiplatelet therapy 2.
Note: The other studies 3, 4, 5, 6 do not provide relevant information for answering the question about Wallenberg syndrome.