Causes of Wallenberg Syndrome - Oren Zarif - Wallenberg Syndrome
A patient presenting with dizziness and intractable hiccups also had symptoms of lateral medullary syndrome. He also had decreased strength in the left arm and leg and had poor temperature sensations on the left side of his face. Moreover, he exhibited difficulty sitting upright and leaned to the left side. MRI of the brain revealed a lateral hyperintense lesion in the left posterior medulla, which confirmed the diagnosis of Wallenberg syndrome.
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The prognosis for people with Wallenberg syndrome varies, and depends on the location and size of the damaged area of the brain stem. Some people recover fully after a few months, while others may experience considerable neurological disability over many years. If left untreated, however, the condition can lead to permanent disability. Nevertheless, it is still not completely clear what the causes of the disease are, and the prognosis is based on individual factors and the severity of the damage.
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The most common cause of Wallenberg syndrome is ischemic stroke of the brain stem, which is caused by a thrombus or embolism. Other less common causes of this disorder include mechanical trauma to the vertebral artery in the neck, arteriovenous malformations, and multiple sclerosis. In severe cases, the condition may lead to permanent neurological problems. While the prognosis of Wallenberg syndrome depends on the underlying cause, treatment is generally supportive and can lead to improvement in symptoms within weeks.
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Optic nerve damage caused by a lesion in the lateral medullary region is another possible cause of Wallenberg syndrome. It is often accompanied by nystagmus. The nystagmus may be horizontal, torsional, or vertical. The abnormalities are characterized by irregular eye movements. However, in rare cases, the condition can also cause impaired visual function. This is why the condition is best treated with ophthalmic surgery.
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Patients with lateral medullary syndrome may also experience hiccups, diplopia, and unilateral posterior headache. During the acute phase, the patient may experience dysphagia, requiring assistance with feeding. A nasogastric tube may be required. In a majority of cases, the patient will recover well from the lateral medullary infarct, and can resume oral feeding within one to two months.
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MRI is the preferred imaging procedure for acute strokes, although CT may also be used to help pinpoint the exact location of infarction. While CT may be useful for diagnosing wallenberg syndrome, MRI is more reliable at locating infarctions in the medulla. The diagnosis of the condition depends on the patient's clinical condition, as early detection is crucial. It is important to perform a proper clinical examination in all patients with wallenberg syndrome.
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The prognosis of patients with Wallenberg syndrome is generally better than that of patients with other acute ischemic strokes. However, a patient with this syndrome may experience lingering issues with walking and balance. Treatment for Wallenberg syndrome includes treating symptoms associated with stroke and addressing the underlying causes. Patients may be prescribed antiemetics for persistent nausea, and occupational therapists administer VitalStim to help them overcome their difficulties in swallowing.
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Neurophysiological studies have suggested that LMI causes a unilateral lesion in WS that affects the oropharyngeal swallowing muscles. It appears to disrupt the communication between premotor neurons in the nucleus ambiguus and their counterparts in the contralateral nucleus ambiguus. While these findings are not conclusive, these findings suggest that LMI may play a role in causing dysphagia.
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Electrophysiological studies of patients with WS have demonstrated a higher incidence of oral and pharyngeal swallowing problems than in healthy controls. However, the extent of the lesion may determine the severity and duration of dysphagia in WS patients. A recent study also noted a connection between hemispheric stroke and WS. In addition, laryngeal elevation is delayed in WS patients.