Lateral medullary syndrome

Lateral medullary syndrome
The three major arteries of the cerebellum: the SCA, AICA, and PICA. (Posterior inferior cerebellar artery is PICA.)
ICD-10	G46.3
DiseasesDB	10449
MeSH	D014854

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Wallenberg's syndrome; posterior inferior cerebellar artery syndrome

Overview

Lateral medullary syndrome is a neurological condition caused by a stroke in the vertebral or posterior inferior cerebellar artery of the brain stem.

Historical Perspective

This syndrome was first described in 1808 by Gaspard Viesseux,. First descriptions by Adolf Wallenberg were in 1895 (clinical) and 1901 (autopsy findings).

Pathophysiology

The syndrome results from occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts.

Natural History, Complications and Prognosis

The outlook for someone with lateral medullary 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. Others may be left with significant neurological disabilities for years after the initial symptoms appeared.

Diagnosis

Symptoms

Symptoms include

• Ageusia or loss of taste on one side of the tongue
• Ataxia or incoordination
• Diplopia or double vision
• Dizziness
• Dysphagia or difficulties with swallowing
• Dysphonia or hoarseness
• Dysarthria or slurred speech
• Facial pain
• Falling
• Hiccups
• Hoarseness
• Impaired gait
• Impaired coordination
• Hypesthesia or lack of pain and temperature sensation on only one side of the face
• Nystagmus or rapid involuntary movements of the eyes
• Nausea and vomiting
• Sense that the world is tilting
• Vertigo

Physical Examination

Neurologic

• Sensory deficits affecting the trunk and extremities on the opposite side of the infarct
• Sensory and motor deficits affecting the face and cranial nerves on the same side with the infarct.
• Ataxia
• Nystagmus,
• Horner's syndrome
• Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex

MRI

Clinical B1000 diffusion weighted MRI image showing an acute left sided dorsal lateral medullary infarct

Localization of the Lesion

Dysfunction	Effects
lateral spinothalamic tract	contralateral deficits in pain and temperature sensation from body
spinal trigeminal nucleus	ipsilateral loss of pain and temperature sensation from face
nucleus ambiguus (which affects vagus X and glossopharyngeal nerves IX)	dysphagia, hoarseness, diminished gag reflex
vestibular system	vertigo, diplopia, nystagmus, vomiting
descending sympathetic fibers	ipsilateral Horner's syndrome
central tegmental tract	palatal myoclonus

Treatment

Treatment for lateral medullary syndrome is symptomatic. A feeding tube may be necessary if swallowing is very difficult. Speech/swallowing therapy may be beneficial. 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.

External links

• Template:NINDS