![]() ![]() Table 1: Common signs and symptoms in lateral medullary syndrome:ĭorsolateral middle medulla adjacent to reticular formation Large rostral lesions are associated with severe dysphagia and a higher risk of aspiration pneumonia, resulting in prolonged hospital stays (3). Rostral lesions are more often associated with dysphagia, facial paresis and dysarthria, with less severe gait ataxia and headache than caudal lesions. Ipsilateral facial weakness is far less common but can occur, presumably from rostral extension of the lesion to the ponto-medullary junction. Thus, depending on the size and location of the infarct, patients can present with ipsilateral, contralateral or bilateral facial numbness with or without sensory changes on the body, or isolated numbness in various aspects of the contrlateral trunk or limbs (3). Damage to the trigemino-thalamic tract, which carries pain and temperature information that has decussated from the contralateral spinal nucleus of V, can also cause numbness of the contralateral face. Involvement of the spinothalamic tract causes loss of pain and temperature sensation on part or all of the contralateral body, while damage to the trigeminal spinal tract and nucleus causes loss of pain and temperature sensation on the ipsilateral face, with one or both of these in 85% (6). The commonest clinical symptoms and signs of the lateral medullary syndrome are ataxia, numbness of the face and/or body, and a Horner’s syndrome (Table 1). Similar lateral medullary syndromes have been reported with demyelination, neoplasm, cavernous malformations and infectious processes (4, 5). ![]() Concomitant cerebellar infarction can be seen with lateral medullary syndrome. A recent review of 130 cases of Wallenberg’s found 50% to be associated with large vessel disease, with the remaining proportion being due to dissection (15%), small vessel disease (13%), cardioembolism (5%), Moya-moya in one patient and unknown causes (15%)(3). They are most commonly associated with infarction in the territory of the posterior inferior cerebellar artery, though 75-90% of large-vessel lateral medullary syndrome is due to vertebral artery disease with the remaining majority being due to isolated PICA infarcts (2). Lateral medullary infarctions (lateral medullary syndrome) comprise approximately 2% of ischemic stroke (1). Wallenberg’s lateral medullary syndrome contributed by Thalia Field and Jason Barton, University of British Columbia, March 2010 ETIOLOGY Superior oblique myokymia, or microtremor ![]()
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