Tag: visualeditor-wikitext |
Tags: mobile edit mobile web edit |
| Line 1: |
Line 1: |
| | Lateral Medullary Syndrome |
|
| |
|
| '''Lateral medullary syndrome''' is a [[neurological disorder]] causing a range of symptoms due to [[ischemia]] in the lateral part of the [[medulla oblongata]] in the [[brainstem]]. The ischemia is a result of a [[Vascular occlusion|blockage]] most commonly in the [[Vertebral artery|vertebral artery]] or the [[posterior inferior cerebellar artery]]. | | Lateral Medullary Syndrome, also known as Wallenberg's syndrome, is a neurological condition caused by a stroke in the lateral part of the medulla oblongata in the brainstem. This syndrome is characterized by a variety of symptoms due to the disruption of several neural pathways and cranial nerve nuclei. |
|
| |
|
| <youtube>
| | ==Etiology== |
| title='''{{PAGENAME}}'''
| | Lateral Medullary Syndrome is most commonly caused by an occlusion of the [[posterior inferior cerebellar artery]] (PICA) or the vertebral artery. This leads to ischemia and infarction in the lateral medulla. |
| movie_url=http://www.youtube.com/v/142QC4wVs-A
| |
| &rel=1
| |
| embed_source_url=http://www.youtube.com/v/142QC4wVs-A
| |
| &rel=1
| |
| wrap = yes
| |
| width=750
| |
| height=600
| |
| </youtube>
| |
|
| |
|
| ==Other Names== | | ==Pathophysiology== |
| Lateral medullary syndrome; Posterior inferior cerebellar artery syndrome; PICA syndrome
| | The lateral medulla contains several important structures, including: |
| | * The [[spinothalamic tract]], which carries pain and temperature sensations from the body. |
| | * The [[trigeminal nerve]] nucleus, which carries sensory information from the face. |
| | * The [[vestibular nuclei]], which are involved in balance and eye movements. |
| | * The [[inferior cerebellar peduncle]], which connects the cerebellum to the brainstem. |
| | * The [[nucleus ambiguus]], which controls muscles involved in swallowing and speech. |
|
| |
|
| ==Clinical features==
| | When the blood supply to these areas is interrupted, it results in the characteristic symptoms of the syndrome. |
| Wallenberg syndrome is a condition that affects the nervous system. Signs and symptoms may include swallowing difficulties, dizziness, hoarseness, nausea and vomiting, nystagmus, and problems with balance. Some people have uncontrollable hiccups, loss of pain and temperature sensation on one side of the face, and/or weakness or numbness on one side of the body. Wallenberg syndrome is often caused by a stroke in the brain stem. Treatment addresses each symptom and may include a feeding tube for swallowing problems, speech and/or swallowing therapy, and medication for pain. While some people's symptoms may improve within weeks or months, others may have long-term neurological problems.
| |
|
| |
|
| [[Image:WallenbergInfarct001.jpg|thumb|Clinical B1000 diffusion weighted MRI image showing an acute left sided dorsal lateral medullary infarct]]
| | ==Clinical Features== |
| | | Patients with Lateral Medullary Syndrome may present with: |
| ==Symptoms== | | * '''Ipsilateral Horner's syndrome''': Due to disruption of the sympathetic pathways, leading to ptosis, miosis, and anhidrosis. |
| Wallenberg syndrome may cause a variety of symptoms depending on the specific cause and the exact location of the damage to the brain.
| | * '''Contralateral loss of pain and temperature sensation''': Due to damage to the spinothalamic tract. |
| | | * '''Ipsilateral loss of pain and temperature sensation on the face''': Due to involvement of the trigeminal nerve nucleus. |
| Symptoms may include:
| | * '''Dysphagia and dysarthria''': Resulting from damage to the nucleus ambiguus. |
| * pain and temperature sensory loss on one side of the face as well as on the opposite side of the body | | * '''Vertigo, nausea, and vomiting''': Due to involvement of the vestibular nuclei. |
| * rapid involuntary movements of the eyes (nystagmus) | | * '''Ataxia''': Resulting from damage to the inferior cerebellar peduncle. |
| * problems with balance and gait (walking) coordination
| |
| * vomiting
| |
| * vertigo
| |
| * nystagmus
| |
| * dysphagia
| |
| * hoarseness
| |
| * uncontrollable hiccups
| |
| | |
| Horner syndrome (decreased pupil size, a drooping eyelid and decreased sweating on the affected side of the face) with visual deficits
| |
| | |
| ==Cause==
| |
| The most common underlying cause of Wallenberg syndrome is a brain stem stroke in the vertebral or posterior inferior cerebellar arteries of the brain stem. However, several other disorders or conditions reportedly have been associated with Wallenberg syndrome, including:
| |
| | |
| * mechanical trauma to the vertebral artery in the neck
| |
| * vertebral arteritis (inflammation of the wall of the artery)
| |
| * metastatic cancer | |
| * hematoma
| |
| * aneurysm of the vertebral artery
| |
| * herpetic brainstem encephalitis (relating to herpes)
| |
| * head injury
| |
| * arteriovenous malformations (AVMs)
| |
| * multiple sclerosis
| |
| * varicella infection
| |
| * brainstem tuberculoma (a rare form of tuberculosis)
| |
| | |
| ===Based on location ===
| |
| | |
| {| class="wikitable"
| |
| |+ Features of lateral medullary syndrome
| |
| | '''Dysfunction''' || '''Effects'''
| |
| |-
| |
| | [[Vestibular nuclei]] || [[Vestibular system]]: [[Vomiting]], [[Vertigo (medical)|vertigo]], [[Pathologic nystagmus|nystagmus]]
| |
| |-
| |
| | [[Inferior cerebellar peduncle]] || [[Ipsilateral]] cerebellar signs including [[ataxia]], [[dysmetria]] (past pointing), [[dysdiadochokinesia]]
| |
| |-
| |
| | [[Central tegmental tract]] || [[Palatal myoclonus]]
| |
| |-
| |
| | [[Lateral spinothalamic tract]] || [[Contralateral]] deficits in pain and temperature sensation from body (limbs and torso)
| |
| |-
| |
| | [[Spinal trigeminal nucleus]] & tract || Ipsilateral deficits in pain and temperature sensation from face
| |
| |-
| |
| | [[Nucleus ambiguus]] - (which affects [[vagus nerve]] and [[glossopharyngeal nerve]]) - localizing lesion (all other deficits are present in lateral pontine syndrome as well) || Ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis: [[dysphagia]], [[hoarseness]], absent [[gag reflex]] (efferent limb—CN X)
| |
| |-
| |
| | Descending [[sympathetic fibers]] || Ipsilateral [[Horner's syndrome]] (ptosis, miosis, & anhidrosis)
| |
| |}
| |
|
| |
|
| ==Diagnosis== | | ==Diagnosis== |
| | Diagnosis of Lateral Medullary Syndrome is primarily clinical, supported by imaging studies such as [[MRI]] or [[CT scan]] of the brain, which can reveal infarction in the lateral medulla. |
|
| |
|
| Since lateral medullary syndrome is often caused by a stroke, diagnosis is time dependent. 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, along with computed tomography (CT) or magnetic resonance imaging (MRI) to assist in stroke detection. Standard stroke assessment must be done to rule out a concussion or other head trauma.<ref name=":0" />
| | ==Management== |
| | | Management of Lateral Medullary Syndrome involves: |
| ==Treatment== | | * '''Acute stroke management''': Including thrombolysis if the patient presents within the appropriate time window. |
| | | * '''Supportive care''': Such as swallowing therapy for dysphagia and physical therapy for ataxia. |
| Treatment for lateral medullary syndrome is dependent on how quickly it is identified.<ref name=":0" /> Treatment for lateral medullary syndrome involves focusing on relief of symptoms and active rehabilitation to help patients return to their daily activities. Many patients undergo [[Speech Therapy|speech therapy]]. Depressed mood and withdrawal from society can be seen in patients following the initial onslaught of symptoms.
| | * '''Symptomatic treatment''': For vertigo and pain. |
| | |
| In more severe cases, a feeding tube may need to be inserted through the mouth or a [[gastrostomy]] may be necessary if swallowing is impaired. In some cases, medication may be used to reduce or eliminate residual pain. Some studies have reported success in mitigating the chronic [[neuropathic]] pain associated with the syndrome with anti-[[epileptic]]s such as [[gabapentin]]. Long term treatment generally involves the use of antiplatelets like aspirin or clopidogrel and statin regimen for the rest of their lives in order to minimize the risk of another stroke.<ref name=":0" /> Warfarin is used if atrial fibrillation is present. Other medications may be necessary in order to suppress high blood pressure and risk factors associated with strokes. A blood thinner may be prescribed to a patient in order to break up the infarction and reestablish blood flow and to try to prevent future infarctions.<ref name=":1">{{cite web|title=Wallenberg Syndrome|url=https://www.physio-pedia.com/Wallenberg_Syndrome|website=Physiopedia|accessdate=7 November 2017}}</ref>
| |
| | |
| One of the most unusual and difficult to treat symptoms that occur due to Wallenberg syndrome are interminable, violent hiccups. The [[hiccup]]s can be so severe that patients often struggle to eat, sleep and carry on conversations. Depending on the severity of the blockage caused by the [[stroke]], the hiccups can last for weeks. Unfortunately there are very few successful medications available to mediate the inconvenience of constant hiccups.
| |
| | |
| For dysphagia symptoms, repetitive [[transcranial magnetic stimulation]] has been shown to assist in rehabilitation. Overall, traditional stroke assessment and outcomes are used to treat patients, since lateral medullary syndrome is often caused by a stroke in the lateral medulla.<ref name=":1" /> | |
| | |
| Treatment for this disorder can be disconcerting because some individuals will always have residual symptoms due to the severity of the blockage as well as the location of the infarction. Two patients may present with the same initial symptoms right after the stroke has occurred, but after several months one patient may fully recover while the other is still severely handicapped. This variation in outcome may be due to but not limited to the size of the infarction, the location of the infarction, and how much damage resulted from it.<ref>http://www.healthline.com/galecontent/wallenberg-syndrome</ref>
| |
|
| |
|
| ==Prognosis== | | ==Prognosis== |
| The outlook for someone with lateral medullary syndrome depends upon the size and location of the area of the brain stem damaged by the stroke. Some individuals may see a decrease in their symptoms within weeks or months. Others may be left with significant neurological disabilities for years after the initial symptoms appeared. | | The prognosis of Lateral Medullary Syndrome varies depending on the extent of the infarction and the timeliness of treatment. Some patients may recover significantly with rehabilitation, while others may have persistent deficits. |
|
| |
|
| ==See also== | | ==See Also== |
| * [[Alternating hemiplegia of childhood]] | | * [[Stroke]] |
| * [[Benedikt syndrome]] | | * [[Brainstem]] |
| * [[Lateral pontine syndrome]] | | * [[Cerebellum]] |
| * [[Medial medullary syndrome]]
| |
| * [[Weber's syndrome]]
| |
|
| |
|
| {{Cerebrovascular diseases}}
| | ==Categories== |
| {{Lesions of spinal cord and brainstem}}
| | [[Category:Neurology]] |
| {{CNS diseases of the nervous system}}
| |
| {{DEFAULTSORT:Lateral Medullary Syndrome}}
| |
| {{stub}}
| |
| [[Category:Stroke]] | | [[Category:Stroke]] |
| [[Category:Syndromes affecting the nervous system]] | | [[Category:Brainstem disorders]] |
| | [[Category:Medical syndromes]] |
| | |
| | {{Neurology-stub}} |
Lateral Medullary Syndrome
Lateral Medullary Syndrome, also known as Wallenberg's syndrome, is a neurological condition caused by a stroke in the lateral part of the medulla oblongata in the brainstem. This syndrome is characterized by a variety of symptoms due to the disruption of several neural pathways and cranial nerve nuclei.
Etiology
Lateral Medullary Syndrome is most commonly caused by an occlusion of the posterior inferior cerebellar artery (PICA) or the vertebral artery. This leads to ischemia and infarction in the lateral medulla.
Pathophysiology
The lateral medulla contains several important structures, including:
When the blood supply to these areas is interrupted, it results in the characteristic symptoms of the syndrome.
Clinical Features
Patients with Lateral Medullary Syndrome may present with:
- Ipsilateral Horner's syndrome: Due to disruption of the sympathetic pathways, leading to ptosis, miosis, and anhidrosis.
- Contralateral loss of pain and temperature sensation: Due to damage to the spinothalamic tract.
- Ipsilateral loss of pain and temperature sensation on the face: Due to involvement of the trigeminal nerve nucleus.
- Dysphagia and dysarthria: Resulting from damage to the nucleus ambiguus.
- Vertigo, nausea, and vomiting: Due to involvement of the vestibular nuclei.
- Ataxia: Resulting from damage to the inferior cerebellar peduncle.
Diagnosis
Diagnosis of Lateral Medullary Syndrome is primarily clinical, supported by imaging studies such as MRI or CT scan of the brain, which can reveal infarction in the lateral medulla.
Management
Management of Lateral Medullary Syndrome involves:
- Acute stroke management: Including thrombolysis if the patient presents within the appropriate time window.
- Supportive care: Such as swallowing therapy for dysphagia and physical therapy for ataxia.
- Symptomatic treatment: For vertigo and pain.
Prognosis
The prognosis of Lateral Medullary Syndrome varies depending on the extent of the infarction and the timeliness of treatment. Some patients may recover significantly with rehabilitation, while others may have persistent deficits.
See Also
Categories
This article is a stub. You can help WikiMD by expanding it!
