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Wallenberg's Syndrome

According to the National Institute of Neurological Disorders and Stroke “Wallenberg’s syndrome is a neurological disorder characterized by swallowing difficulties and hoarseness which results from paralysis of a portion of the vocal cord.” This occurs when the PICA (Posterior Inferior Cerebellar Artery) becomes blocked causing dizziness, paralysis of the facial muscles, loss of taste and a tilt to the patient’s environment, which promulgates a loss of balance. In many cases, Wallenberg’s syndrome is difficult to diagnose as many of its symptoms mimic those of Horner’s syndrome. Magnetic resonance imaging can provide the definitive diagnosis however as medullary infarction can be easily discerned.

Wallenberg's Syndrome

Despite the fact that specific statistics on the prevalence of Wallenberg’s syndrome are not available, research suggests that of the brain stem occlusions that can occur PICA or Wallenberg’s occlusion are the most prevalent. Research in children shows that this condition is incredibly are with only five cases current being reported in the literature . An author goes on to note that in patients with lateral medullary infarct (LMI), 75 percent suffer from occluded PICA. “Symptoms of lateral medullary syndrome consist of vertigo, headache, facial pain, dysequilibrium, nausea and vomiting, ataxia, hiccups, and contralateral burning pain.”

Of all the symptoms associated with Wallenberg’s syndrome the first on to manifest is typically facial pain. This is due in part of the “descending tract of CNV.” This is typically followed by the onset of dysequilibrium or a sense of seasickness. Although “extraocular muscles, visual fields, and visual acuity remain intact” visual dysfunction due to vestibular nerve involvement is common. Abnormal gait is almost always present as well. For patients this symptom may be associated with weakness that can prevent standing or sitting. However, upon examination no notable weakness is evident. Difficulty swallowing is also typical in patients with this condition. “Difficulty swallowing has been related to dyscoordination of the epiglottic closure, palate, and pharynx due to a central lesion in the nucleus ambiguus.” Finally, sensory deficits of pain and temperature are reported on the ipsilateral face and contralateral body.

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