lateral medullary syndrome

Lateral
Medullary Syndrome. Clinical B1000 diffusion weighted MRI image showing an acute infarct in the left dorsal lateral medulla.
Wikipedia • Public domain
Lateral
medullary syndrome • Vertebral artery dissection with lateral medullary (Wallenberg's) syndrome - Ganzer Fall bei Radiopaedia
ElBeialy M, Vertebral artery dissection with lateral medullary (Wallenberg's) syndrome. Case study, Radiopaedia.org (Accessed on 23 Jun 2023) https://doi.org/10.53347/rID-38080 • CC by-nc-sa 3.0 (modified)
Imaging of
cranial nerves: a pictorial overview. Wallenberg syndrome. Patient with left sensory loss, gait ataxia, nausea, and vertigo. MRI DWI (b1000) image demonstrates area of diffusion restricted in the left dorsal medulla oblongata, suggestive for recent ischemic lesion (dotted circle)
insightsimaging.springeropen.com • CC-by-4.0
Lateral
medullary syndrome • Lateral medullary syndrome and possible DNET - Ganzer Fall bei Radiopaedia
Jha P, Lateral medullary syndrome and possible DNET. Case study, Radiopaedia.org (Accessed on 23 Jun 2023) https://doi.org/10.53347/rID-17410 • CC by-nc-sa 3.0 (modified)
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frischer Defekt dorsolateral in der Medulla oblongata rechts mit der Klinik eines Wallenberg-Syndroms. Oben axial T2, DWI und T1 mit KM sagittal; unten axial T1 mit KM, ADC und FLAIR sagittal.
Wikipedia • CC BY-SA 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Lateral medullary syndrome, also known as Wallenberg syndrome, is a clinical syndrome caused by an acute ischemic infarct of the lateral medulla oblongata. This is most commonly due to occlusion of the intracranial portion of the vertebral artery followed by PICA and its branches .

Epidemiology

20% of ischemic strokes occur in the posterior circulation . Lateral medullary syndrome is the most prevalent posterior ischemic stroke syndrome .

Risk factors

Hypertension is the commonest risk factor followed by smoking and diabetes mellitus .

Clinical presentation

This syndrome is characterized by:

  • vestibulocerebellar symptoms: vertigo, falling towards the side of lesion, diplopia, and multidirectional nystagmus (inferior cerebellar peduncle and vestibular nucleus) 
  • autonomic dysfunction: ipsilateral Horner syndrome, hiccups 
  • sensory symptoms: initially abnormal stabbing pain over the ipsilateral face then loss of pain and temperature sensation over the contralateral side of body (spinal trigeminal nucleus involvement) 
  • ipsilateral bulbar muscle weakness: hoarseness, dysphonia, dysphagia, and dysarthria, decreased gag reflex (nucleus ambiguus) 

Pathology

Etiology

Lateral medullary syndrome is caused most commonly by:

  • atherothrombotic occlusion of the vertebral artery, the posterior inferior cerebellar artery, or the medullary arteries
  • cerebral embolism
  • vertebral artery dissection, the commonest cause in young patients

Radiographic features

MRI

MRI with DWI is the best diagnostic test to confirm the infarct in the lateral medulla . The infarcted area has high DWI signal and is low signal on ADC .

History and etymology

The syndrome was first described by Adolf Wallenberg (1862-1949), a German physician, in 1895 .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Wallenberg-Syndrom:
Dissektion
Arteria vertebralis
jaclinicalreports.springeropen.com • CC-by-4.0
Arteria
cerebelli inferior posterior (PICA)
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