Lateral medullary syndrome

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Lateral medullary syndrome
CerebellumArteries.jpg
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,[1]. 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

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.

References

External links

de:Wallenberg-Syndrom



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