Wallenberg Syndrome

Wallenberg Syndrome (WS) is a neurological disorder that gives rise to several problems related to swallowing or eye movements. Get detailed information about the disorder, including its causes, symptoms, diagnosis, or treatment options.

What is Wallenberg Syndrome?

According to the anatomy of the brain, cerebellum is responsible for motor control and medulla is equally important in controlling the autonomic functions. Blood is supplied to these regions of the brain by two vertebral arteries which might suffer a blood clot or blockage, leading to disruption in its functions. This further causes a series of neurological symptoms to develop, that causes necrosis and tissue ischemia. This resulting disease is called Wallenberg syndrome.

WS is also known by the name of Lateral medullary syndrome.

Wallenberg Syndrome History

This syndrome was brought into notice by a Swiss physician named Gaspard Vieusseux (1746to1814). He was the first person to describe this condition along with Bacterial meningitis. However, the disease was eventually named after the German neurologist Adolf Wallenberg who came up with a correct description of the pathology, following an autopsy.

Wallenberg Syndrome ICD-9 Code

The ICD9 code of this syndrome is 436.

What causes Wallenberg Syndrome?

The main cause of WS is a stroke or occlusion in the vertebral artery or posterior inferior cerebellar artery. PICA or posterior inferior cerebellar artery has several branches; occlusion in these can also lead to this syndrome. In this syndrome, the lateral medulla of the brain is usually damaged; although the cerebellum can also be injured. The major cranial nerves associated with this syndrome are IX and X, known as Glossopharyngeal and Vagus nerves.

Wallenberg Syndrome Symptoms

A host of symptoms occur with the onset of this condition, which basically include paralysis, sensory problems and issues with balancing. The symptoms arise due to the dysfunction of:

Picture 1 – Wallenberg Syndrome

  • Vestibular nuclei
  • Central tegmental tract
  • Inferior cerebellar penduncle
  • Spinal trigeminal nucleus
  • Spinal trigeminal tract
  • Lateral spinothalamic tract

In almost half of all patients suffering stroke, neurological symptoms are prominent for some weeks. Some of these are:

  • Dysphagia or trouble in swallowing
  • Vomiting
  • Nausea
  • Difficulties in gait coordination and balance
  • Husky voice
  • Severe hiccups, which do not seem to subside.
  • Pain on the face, which feels like sharp jerks around the forehead, eyes and ears
  • Vertigo
  • Double vision
  • Changes or loss in sensation in the limbs on the opposite side
  • Droopy eye lid, on the affected side
  • Clumsy movements of limb
  • Loss of hearing, in some cases

Wallenberg Syndrome Diagnosis

It is really important to distinguish the distinct symptoms of this syndrome before treating them like regular vomiting or vertigo. A physician adept in diagnosing it should be approached and a thorough medical checkup comprising physical exam and imaging should be conducted. Some of the main diagnostic tests for WS are:

MRI scans

Magnetic Resonance Imaging (MRI) is used to depict the stroke in the medulla. It provides excellent imaging for this syndrome.

CT scans

This diagnostic test is also used to detect the position of infarcts in the brain.

Blood count test/spiral scans

For determining the occurrence of this syndrome, blood count test can be performed to show if there is any blocked artery in the spinal cord or brain which is causing it. Similarly, blocked arteries can be confirmed by spiral scans and angiography.

Wallenberg Syndrome Differential Diagnosis

The symptoms of this condition may present an impression of Horner Syndrome. This mainly occurs due to the injury caused to the hypothalamospinal fibers. Doctors must ensure that the symptoms experienced by sufferers are not the result of Horner Syndrome.

Wallenberg Syndrome Treatment

The treatment of this syndrome generally addresses its symptoms, which show up. It is followed by rehabilitation to enable the affected individuals to again get back in form. Some of the treatments modes including therapies and medication are as follows:

  • To tackle swallowing difficulty, the patient might need a feeding tube which is put through the mouth. Gastrostomy is yet another procedure adopted to deal with it.
  • Speech therapy might be effective for regaining lost speech.
  • To prevent further blood clot, heparin (blood thinner) is administered intravenously. This might as well signal the beginning of a life-long routine of taking blood thinners.
  • To control cholesterol and high blood pressure, medication is required.
  • To deal with the debilitating pain, narcotics are administered beside analgesics. For managing vomiting and nausea, medication is prescribed.
  • Hiccups are very difficult to treat. Yet, there are some effective medicines available for treating prolonged hiccups that impair the patient’s ability to talk, sleep or eat.
  • Occupational therapy is beneficial for enhancing the patient’s living skills, which would be employed in his/her daily lives.
  • For dealing with the balance and walking problems, physical therapies might be an added advantage.

Wallenberg Syndrome Recovery

For recovery from WS, several treatment plans are adopted in which therapies form a substantial part for rehabilitating the patients. To assist patients in walking, walkers or cane can be offered along with wheelchair for mobility. Wholly solid foods must be avoided to avoid complications while feeding. It is always better to hospitalize patients for some time for allowing them to slowly adjust to the surroundings. Apart from these, it is also essential to lend emotional support to WS patients.

Wallenberg Syndrome Risk Factors

Individuals considering themselves to be at risk of having this disorder should avoid the following factors that increase the risk of a stroke:

Picture 1 – Wallenberg Syndrome Image

  • Being obese or not maintaining healthy weight.
  • High levels of cholesterol and blood pressure.
  • Leading a sedentary lifestyle.
  • Diabetes or other metabolic ailments.
  • Tobacco abuse.

Wallenberg Syndrome Prognosis

The prognosis for WS seems to be favorable and depends on the extent of damage caused to the brain. In most cases, occupational, speech and physical therapies work in the favor of a patient and helps him regain speech and other abilities. Some of the symptoms may decrease in few weeks while some may take several months to recover. In some other cases, sufferers may be left with neurological disabilities. In rare cases, about 10% patients may die due to complications resulting out of the syndrome.

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