DOI: https://dx.doi.org/10.18203/2349-3933.ijam20222959
Published: 2022-11-23

Lateral medullary syndrome: an unwanted ischemia to identify early

Priyadarshi Prajjwal, Pugazhendi Inban, Abhijit Nagre, Mujtaba Hussain Shah, Ansh Chaudhary, Raunak Ranjan, Bhupendra Chaudhary

Abstract


Lateral medullary syndrome also referred to as Wallenberg syndrome, posterior inferior cerebellar artery (PICA) syndrome, or vertebral artery syndrome is a cluster of neurological symptoms and signs brought on by obstructions in the blood vessels supplying the medulla, which causes ischemia or infarction of the brainstem. The vertebral artery or the posterior inferior cerebellar artery are the arteries most frequently affected with lateral medullary syndrome. The most prevalent symptom is transient ischemic attack (TIA) with dizziness or vertigo and atherosclerosis in the posterior cerebral circulation being the most common cause. Lateral Medullary Syndrome patients suffer from strokes or infarction and also present with vomiting, nausea, gait impairment, instability, hoarseness, and swallowing difficulties. Depending on the particular nuclei and fibers involved, different indications will appear. CT/MRI imaging is used to diagnose conditions. The majority of management is supportive, including risk factor reduction for additional ischemia events as well as speech and occupational therapy following an acute intervention. In this review article, we discuss the etiopathogenesis and factors leading to lateral medullary syndrome along with a comprehensive discussion on its clinical features, challenges in diagnosis, and treatment.


Keywords


Wallenburg, Lateral medulla, Stroke, Vertebral artery, Horner’s syndrome

Full Text:

PDF

References


Day GS, Swartz RH, Chenkin J, Shamji AI, Frost DW. Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review. CJEM. 2014;16(2):164-70.

Lui F, Tadi P, Anilkumar AC. Wallenberg Syndrome. Treasure Island (FL): StatPearls Publishing; 2022.

Aminoff M. Encyclopedia of the neurological sciences. 2nd ed. Tomah, WI: Academic Press. 2015; 744.

Pandey S, Batla A. Opalski's syndrome: A rare variant of lateral medullary syndrome. J Neurosci Rural Pract. 2013;4(1):102-4.

Mujeeb VR, Tyagi A, Jambunathan P. A case of lateral medullary syndrome with unilateral selective thermoanaesthesia. Int J Med Res Rev. 2019;7(1):50-3.

Saleem F, M Das J. Lateral Medullary Syndrome. Treasure Island (FL): StatPearls Publishing; 2022.

Day GS, Swartz RH, Chenkin J, Shamji AI, Frost DW. Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review. CJEM. 2014;16(2):164-70.

Kang H, Kim B, Lee S. Lateral medullary infarction with or without extra-lateral medullary lesions: what is the difference? Cerebrovasc Dis. 2018;45:132-40.

Alawadhi A, Saint-Martin C, Sabapathy C, Sebire G, Shevell M. Lateral medullary syndrome due to left vertebral artery occlusion in a boy postflexion neck injury. Child Neurol. 2019;6:24-9.

Renjen PN, Krishnan R, Chaudhari D, Ahmad K. An atypical presentation of left lateral medullary syndrome-a case report. Neurol India. 2021;69:1831-4.

Jiang YE, Lyu QQ, Lin F, You XT, Jiang ZL. Hyoid-complex elevation and stimulation technique restores swallowing function in patients with lateral medullary syndrome: Two case reports. World J Clin Cases. 2020;8(6):1142-9.

Tarnutzer AA, Berkowitz AL, Robinson KA. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ. 2011;183:E571-91.

Kattah JC, Talkad AV, Wang DZ. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke. 2009; 40:3504-10.

National Institute of Neurological Disorders and Stroke rtPA Stroke Sudy Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581-7.

Hopyan JJ, Gladstone DJ, Mallia G. Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol. 2008;29:1826-30.

Hwang DY, Silva GS, Furie KL. Comparative sensitivity of computed tomography vs. magnetic resonance imaging for detecting acute posterior fossa infarct. J Emerg Med. 2012;42:559-65.

Chalela JA, Kidwell CS, Nentwich LM. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. Lancet. 2007; 369:293-8.

Engelter ST, Rutgers MP, Hatz F. Intravenous thrombolysis in stroke attributable to cervical artery dissection. Stroke. 2009;40:3772-6.

Razzaq F, Patel K. Wallenburg’s syndrome (Lateral Medullary Syndrome). Eurorad. 2007.