Incessant hiccups are highly correlated with the presentation of hoarseness and dysphagia and are likely due to infarction affecting the nucleus ambiguus. Horner's syndrome (constricted pupil & drooping eyelid)Īmong these, sensory symptoms & signs, gait ataxia, dizziness, and Horner's sign are the most common, with sensory symptoms & signs occurring in up to 96% of all lateral medullary infarct patients less common, but still present in at least 50% of cases, are dysphagia, hoarseness, vertigo, nystagmus, limb ataxia, nausea/vomiting, and headache.Dysphonia (difficulty with sound production).Contralateral reduction in trunk pain & temperature sensation.Ipsilateral reduction in facial pain & temperature sensation.Some symptoms associated with Wallenberg Syndrome include : Clinical presentations vary depending on which specific nuclei and fibres are involved. Ĭlinical Picture based on Location (Nicholson, 2009).ĭue to the very compressed placement of nuclei and tracts within the lateral medulla, Wallenberg Syndrome resulting from a stroke in the VA or PICA often leads to abnormalities in many systems, including the vestibulo-cerebellar, sensory, bulbar, respiratory, and autonomic systems. Īs the cerebellum is perfused by, inter alia, the PICA, interruption of the vascular supply in Wallenberg Syndrome can also often result in some degree of cerebellar dysfunction, though this is not classically considered part of the disease. The region of the lateral medulla is bordered by the anterior lateral sulcus ventrally, the posterior lateral sulcus dorsally, the pons rostrally and the spinal cord caudally. Structures that make up the lateral medulla include the inferior cerebellar peduncle, vestibular nuclei, trigeminal nucleus and tract, spinothalamic tract, descending sympathetic fibres, nucleus ambiguous and nucleus solitarius. Prior to joining together at the midline to form the basilar artery, both the left and right VA branch off to form, respectively, left and right posterior inferior cerebellar arteries (PICA), which themselves run dorsally and cross over to supply the lateral medulla on their way to the cerebellum.
The left and right vertebral arteries (VA) run along the ventrolateral aspect of the brainstem, supplying the medulla. However, a more detailed description given in 1895 by Adolf Wallenberg highlighted this condition as an infarction of the lateral medulla oblongata following occlusion of the VA/PICA. Wallenberg Syndrome was first described in 1808 by Gaspard Vieusseux. Stroke occurring in this region of the brainstem often leads to a variety of impairments, and patients typically present with motor, sensory, cognitive, perceptual, speech and language deficits. According to the National Institute of Neurological Disorders and Stroke, Wallenberg Syndrome (aka Lateral Medullary Syndrome or Posterior Inferior Cerebellar Artery Syndrome) is a neurological condition caused by a blockage of the vertebral artery (VA) or posterior inferior cerebellar artery (PICA), ultimately leading to infarction of the lateral medulla.
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