Lateral medullary syndrome


A neurological disorder causing a range of symptoms due to ischemia in the lateral part of the medulla oblongata in the brainstem.

Also called Wallenberg syndrome, posterior inferior cerebellar artery syndrome, PICA syndrome, vertebral artery syndrome, and Wallenberg’s syndrome.

Ischemia results from a blockage in the posterior inferior cerebellar artery or one of its branches.

Those at highest risk are men at an average age of 55.

A history of hypertension, diabetes and smoking all increase the risk of large artery atherosclerosis.

Large artery atherosclerosis due to plaque buildup is thought to be the greatest risk factor as a result of deposits of cholesterol, fatty substances, cellular waste products, calcium and fibrin.

Lateral medullary syndrome can affect structures-vagus nerve, #10=acoustic nucleus, nucleus gracilis, nucleus cuneatus, head of posterior column and lower sensory root of trigeminal nerve and lingula.

Characterized by sensory deficits that affect the trunk and extremities contralaterally, and sensory deficits of the face and cranial nerves ipsilaterally.

Specifically a loss of pain and temperature sensation if the lateral spinothalamic tract is involved.

The chief symptom is cross body findings which helps make the diagnosis.

Often patients have difficulty walking or maintaining balance.

There may be a difference in temperature sensation on one side of the body.

Nystagmus is commonly associated with vertigo spells.

Difficulty swallowing, or dysphagia.are common symptom, as involvement of the nucleus ambiguus, supplying the vagus and glossopharyngeal nerves.

Slurred speech and dysphonia are also common.

Ataxia may result from damage to the cerebellum or the inferior cerebellar peduncle.

Miosis, anhidrosis and partial ptosis may result from damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay.

Twitching of the muscles of the mouth, may be observed due to disruption of the central tegmental tract.

Other symptoms include: hoarseness, nausea, vomiting, decreased, sweating, dizziness, difficulty walking, and difficulty maintaining balance.

Cardiovascular complications include: bradycardia, and blood pressure changes.

The process is the result of occlusion of the posterior inferior cerebellar artery (PICA) 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 of findings.

The most commonly affected artery is the vertebral artery, followed by the posterior inferior cerebellar artery, superior middle and inferior medullary arteries.

Is often caused by a stroke.

Diagnosis is usually done by assessing vestibular-related symptoms in order to determine where in the medulla that the infarction has occurred.

Head Impulsive Nystagmus Test of Skew (HINTS) examination of oculomotor function is often performed.

Computed tomography (CT) or magnetic resonance imaging (MRI) is performed to assist in stroke detection.

Treatment depends on how quickly is it identified.

Treatment involves focusing on relief of symptoms and active rehabilitation.

Associated with depression and withdrawal.

If swallowing is impaired, a feeding tube may be required in severe cases.

Chronic neuropathic pain may be associated with the syndrome.

Long term treatment involves the use of antiplatelet drugs, and statin regimen to minimize the risk of another stroke.

If atrial fibrillation is present oral anticoagulation is I Indicated.

Anti hypertension meds may be required.

Fibrinolytic therapy may be useful in the acute setting.

Violent hiccups may occur with the syndrome, depending on the severity of the stroke.

Hiccups may last for weeks.

Traditional stroke assessment and outcomes are used to treat patients.

There is a significant variation in symptomology patients may experience based of the size, location of the infarction.

Prognosis depends upon the size and location of the area of the brain stem damaged by the stroke.

More than 85% of patients have minimal symptoms present at six months from the time of the original stroke, and are able to independently accomplish average daily within a year.

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