Lateral medullary syndrome
From Wikipedia, the free encyclopedia
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| The three major arteries of the cerebellum: the SCA, AICA, and PICA. (Posterior inferior cerebellar artery is PICA.) | |
| ICD-10 | G46.3 |
| DiseasesDB | 10449 |
| eMedicine | emerg/834 |
| MeSH | D014854 |
Lateral medullary syndrome (also called Wallenberg's syndrome and posterior inferior cerebellar artery syndrome) is a disease in which the patient has difficulty with swallowing or speaking or both owing to one or more patches of dead tissue (known as an infarct) caused by interrupted blood supply to parts of the brain.
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[edit] Cause
It is the clinical manifestation resulting from occlusion of the posterior inferior cerebellar artery or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts, resulting in a typical pattern.
[edit] Clinical features
PICA syndrome (also known as lateral medullary syndrome) presents with the following symptoms:
- contralateral deficits in pain and temperature sensation from body (dysfunction of lateral spinothalamic tract);
- ipsilateral loss of pain and temperature sensation from face (dysfunction of spinal trigeminal nucleus);
- ipsilateral dysphagia, hoarseness, diminished gag reflex (dysfunction of nucleus ambiguus, which affects vagus and glossopharyngeal nerves);
- vestibular dysfunction (vertigo, diplopia, nystagmus, vomiting);
- ipsilateral Horner's syndrome (dysfunction of descending sympathetic fibers).
An affected person may present with ataxia on the side of lesion. Hiccoughs are another common sign. There will be facial numbness on side of the lesion whereas there will be contralateral body numbness.
[edit] Presentation
This syndrome is characterized by sensory deficits affecting the trunk and extremities on the opposite side of the infarct and sensory and motor deficits affecting the face and cranial nerves on the same side with the infarct. Other clinical symptoms and findings are ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia and dysphagia. The cause of this syndrome is usually the occlusion of the posterior inferior cerebellar artery (PICA) at its origin.
The affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, and slurred speech (dysphonia, dysarthria). Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex.
The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation to the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia.
Nystagmus and vertigo, which may result in falling, caused from involvement of the region of Deiters' nucleus and others vestibular nuclei.
Onset is usually acute with severe vertigo.
[edit] Treatment
Treatment for Wallenberg's 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.
[edit] Prognosis
The outlook for someone with Wallenberg’s 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.
[edit] History
This syndrome was first described in 1808 by the Geneva physician Gaspard Viesseux, who rendered an exact description of his own disease at a meeting of the Société médicochirurgicale de Genève. First descriptions by Wallenberg were in 1895 (clinical) and 1901 (autopsy findings).
