Symptoms and Causes of Wallenberg Syndrome - Oren Zarif - Wallenberg Syndrome

Almost all cases of Wallenberg syndrome (WS) are asymptomatic, but a careful neurological examination can be crucial to a correct diagnosis. Symptoms and structures of the posterolateral medulla are involved in about 50% of cases, but partial Wallenberg syndromes are often sufficient for a diagnosis. A diagnosis of WS requires a combination of clinical, electrophysiological, and neuroimaging findings to make an accurate prediction. A patient with WS has an increased risk of stroke, though hemorrhagic stroke is more common and less prominent.

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In a single patient, the symptoms of the syndrome were severe dizziness, a left-sided facial burning sensation, intractable hiccups, decreased strength in the left arm and leg, and weakness in the left extremity. A magnetic resonance imaging (MRI) scan showed a large lateral medullary infarction with involvement of the left middle cerebellar peduncle. The patient was discharged three weeks after the stroke and subsequently improved in a rehabilitation facility.

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Other symptoms of Wallenberg syndrome include uvula deviation, hypotonia of the ipsilateral arm, and abnormalities in ocular alignment. The patient can demonstrate hypotonia by raising and lowering both outstretched hands. The symptomatic arm will overshoot its braking compared to the other arm. Patients with WS may also experience abnormal head tilt. It's important to seek medical attention for any of these symptoms.

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Although the exact cause of Wallenberg syndrome has not been determined, there are a few factors that increase the risk. Some researchers have suggested that dissection of the posterior inferior cerebellar artery causes the syndrome. Smoking and diabetes are also risk factors. Among those afflicted with Wallenberg syndrome, young patients should undergo post-mortem examinations to rule out vertebral artery dissection as the cause of the condition.

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Among the symptoms of Wallenberg syndrome, swallowing problems and hoarseness are common. Patients also experience dizziness, nausea, and rapid eye movements. Some may experience a loss of temperature sensation in the affected side. These symptoms are typically temporary, but may last a long time. Although there are no definitive cures for Wallenberg syndrome, there are treatments available for the condition. A stroke is the most common cause of the syndrome.

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The symptoms of WS are similar to those of a lateral medullary syndrome. A rupture of the posterior inferior cerebellar artery can result in lateral medullary infarction. It is often the result of a blood clot in this area. In some cases, a patient may recover from the condition. Often, it takes several weeks to overcome dysphagia. However, in other cases, the condition can be fatal.

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Although the causes of this rare disorder remain unclear, doctors are able to identify it in the majority of cases. However, the syndrome itself may have a genetic component. Several studies have suggested that a genetic link may be present. For instance, a person with a familial history of SS may have a definite underlying cause. During the postmortem examination, the physician should determine the presence of a lesion and make a diagnosis.

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Various forms of treatment have been used to treat WS. One treatment option is the injection of intravenous tissue-type plasminogen activator. However, this therapy is not effective in patients with WS without treatment. In many cases, speech therapy is beneficial.

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Neuromuscular electrical stimulation (NMES) may help patients regain the ability to swallow. A specialized form of NMES, VitalStim, is FDA-cleared for use in the treatment of pharyngeal dysphagia. Occupational therapists are most likely to administer VitalStim.

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The major clinical findings associated with swallowing dysfunction are summarized in Table 1. Patients with WS show higher incidence of oral and pharyngeal swallowing symptoms than patients with normal hemispheric stroke. Furthermore, WS patients have greater laryngeal elevation delays than those without WS. Other neurological findings of WS include difficulties swallowing food and liquids, and the difficulty of controlling bolus. Further, patients with hemispheric stroke have greater frequency of oral phase disorders.