Wallenberg syndrome is a neurological disorder that occurs when oxygen cannot be delivered to the lateral medulla. A blockage in the arteries may prevent delivering oxygen to the brainstem. It is basically the kind of a stroke or infarction. Wallenberg syndrome is also known as the lateral medullary syndrome, lateral medullary infarction.
The lateral medulla is the lateral part of the medulla oblongata in the brain stem. Failure to convey oxygen in the blood to this area causes ischemia (lack of blood in tissues). This ischemia generally happens by blockage of the vertebral artery or the posterior inferior cerebellar artery. When this happens, various symptoms appear.
We can also say that Wallenberg syndrome is a rare health issue with an unknown origin. This disease was named after Adolf Wallenberg, who described the first case in 1895. Also, it affects about 200,000 people in the United States.
Causes Of Wallenberg Syndrome
Even though the cause of Wallenberg syndrome is not known exactly, some researchers have a few ideas about causes.
The most common underlying cause of Wallenberg syndrome is occlusion of the posterior inferior cerebellar artery (PICA). Also, in the frequency of stroke, the vertebral artery of the brain stem follows the PICA.
Apart from these, other causes associated with Wallenberg syndrome are as follows:
- Mechanical trauma to the vertebral artery in the neck
- Vertebral arteritis (inflammation of the wall of the artery)
- Metastatic cancer
- Aneurysm of the vertebral artery
- Herpetic brainstem encephalitis (relating to herpes)
- Head injury
- Arteriovenous malformations (AVMs)
- Multiple sclerosis
- Varicella infection
- Brainstem tuberculoma (a rare form of tuberculosis)
Symptoms Of Wallenberg Syndrome
The brain stem essentially manages the flow of messages between the brain and the rest of the body. Besides, it is responsible for important body functions such as breathing, swallowing, heart rate, blood pressure, consciousness, and whether one is awake or sleepy.
For this reason, brainstem damage caused by infarction can trigger some disruptions in the vital functions of the body. This neurological disorder causes different symptoms depending on the exact location of the damage to the brain.
Symptoms of Wallenberg syndrome include:
The most common symptom of Wallenberg syndrome is dysphagia (swallowing difficulty).
- Nystagmus (rapid involuntary movements of the eyes)
- Uncontrollable hiccups
- A decrease in sweating
- Problems with body temperature sensation
- Difficulty walking
- Difficulty maintaining balance
- Horner syndrome
- Facial pain and temperature loss
Diagnose For Wallenberg Syndrome
First of all, doctors consider the patient’s health history and symptoms. After this assessment, they perform a neurological examination.
A lateral medullary syndrome is often caused by a stroke. Clinical examination is very important to make a differential diagnosis of whether the condition is caused by a true stroke. In addition to the clinical examination, the use of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) can assist in determining or confirming the exact location of the infarction.
A three-step oculomotor examination called HINTS (Head-Impulsive-Nystagmus-Test-of-Skew) may be beneficial to assist stroke detection. It is a valid and promising tool for determining the presence of a lateral medullary infarction.
Patients with lateral medullary infarction often have vestibular associated symptoms. Defining these symptoms correctly is very important for the diagnosis of Wallenberg Syndrome.
Finally, we can say that imaging devices may always not be reliable to detect an infarction at the medulla level. Therefore, a clinical examination has a very important role in the diagnosis of Wallenberg Syndrome.
How Is Wallenberg Syndrome Treated?
Unfortunately, there isn’t a certain cure for Wallenberg Syndrome. For this reason, doctors primarily prefer a treatment focused on reducing symptoms. In addition, we can say that rehabilitation is an effective procedure for Wallenberg Syndrome.
Rapid evaluation is very critical for successful treatment. Also, the treatment approach to be followed depends on the underlying cause of the problem and when the first diagnosis was made.
Generally, the treatment process includes reducing the size of infarction, preventing any medical complication, and improving patient outcome and prognosis as a final purpose.
Symptomatic Treatment Methods
If there is a serious swallowing problem, it is necessary to use a feeding tube. Also, a gastrostomy may be a proper method in cases where swallowing is impaired. Doctors will prefer speech or swallowing therapy for less swallowing difficulty.
In addition, some patients need medications to control pain. Anti-epileptics such as gabapentin are successful in mitigating the chronic neuropathic pain associated with the syndrome.
Besides that, hiccups are one of Wallenberg syndrome symptoms. Patients with the lateral medullary syndrome may experience interminable severe hiccups depending on the severity of the blockage of the vessels. Unfortunately there are very few successful medications to treat the constant hiccups.
In order to minimize the risk of another stroke, a continuous treatment approach is followed with some medicines. Your doctor may prescribe drugs such as aspirin or clopidogrel and statin for this treatment. If there is a heart problem like atrial fibrillation, it may be helpful to use Warfarin.
If there is high blood pressure or other risky conditions related to stroke, different medicines may be required to be added to this list. It is useful to use blood-thinning drugs to reduce blockage in the vessels and ensure blood flow.
Symptomatic treatment of Wallenberg Syndrome can be long and painful. The recovery rate is variable for each patient. This rate depends on the severity of the blockage and the amount of damage in the brain stem.
- A feeding tube to help with swallowing complications
- Speech and/or swallowing therapy to help with talking and swallowing
- Medication to help alleviate pain, such as the anti-epileptic drug gabapentin (Neurontin)
- Blood thinner medication, such as heparin or warfarin (Coumadin), to help reduce or dissolve the blockage in the artery
- Rarely, and only in extreme cases, surgery may be an option to remove the clot