Other rarer causes such as vertebral artery dissection especially in predisposed younger individuals with Ehlers Danlos syndrome, Marfan syndrome, fibromuscular dysplasia and hypoplastic vertebral artery have been noted in prior literature. Primary etiologies include atherosclerosis, hypertension and other vasculopathic risk factors. While most commonly due to PICA occlusion, other arteries, such as the vertebral artery or branches of PICA, can be involved as well. WS is most commonly due to an occlusion of the PICA, resulting in ischemia and infarction of the lateral medulla. The blood flow and the cross-sectional anatomy of the medulla are illustrated in figures 1 and 2.įigure 2: cross-sectional anatomy of medulla including all nuclei and tracts Etiology The anterior spinal artery has its own median medullary branch, which perfuses the anteromedial region of the medulla. The anterior spinal artery provides blood flow to the remainder of the medulla. The medial medullary branch of PICA perfuses the anterior lateral medulla, and the lateral medullary branch perfuses the lateral medulla. The dorsal medullary branch of PICA perfuses the posterior medulla. The vertebral artery supplies the posterior inferior cerebellar artery (PICA), which has 3 main branches: the dorsal, medial, and lateral medullary branches. The primary blood supply to the medulla comes from the vertebral arteries. These regions are divided based on their differing arterial supply.

The medulla can be divided into 4 regions: anteromedial, anterolateral, lateral, and posterior ( Figure 1). This monograph highlights the neuro-ophthalmic presentations for the WS. WS is typically due to ischemia from a vertebral artery or posterior inferior cerebellar artery infarction. Wallenberg syndrome (WS) is a neurological disorder that is due to damage to the lateral portion of the medulla oblongata (i.e., the lateral medullary syndrome). Secondary persistent or recurrent facial ulcerationī. May be associated with Wallenburg's syndrome and is a rare cause of facial ulcerations associated with injury to the trigeminal nerve (Parimalam 2014) with the syndrome comprised of triad ofģ. involvement of central tegmental tract: palatal myoclonusĪ.involvement of Deiters' nucleus and other vestibular nuclei: nystagmus and vertigo.involvement of hypthalamic fibers: sympathetic nervous system abnormal c/w Horners syndrome.involvement of spinothalamic tract: loss of pain and temperature sensation to the opposite side of body.involvement of trigeminal nucleus: ipsilateral facial and corneal anesthesia.laryngeal, pharyngeal and palatal paralysis.involvement of nucleus ambiguus: dysphagia, dysphonia and dysarthria.Vertebral artery dissection associated with:.Hypertension is most common risk factor with other causes.Most commonly caused by atherothrombotic occlusion of the vertebral artery (then posterior inferior cerebellar arteray and least often the medullary arteries.Estimated 60,000 new cases in the United States each year with usually a better outcome - with most common sequelae being gait instability and most patients returning to satisfactory activities of daily living(Lui 2019). A complete Wallenberg syndrome is not common with key factors in clinical diagnosis being 'crossed hemiparesis or hemianesthesia' indicating a brainstem lesionĥ. may also be associated with obstructive sleep apnea and airway obstruction (Vaidyanathan 2007)Ĥ.Otolaryngological features include dysphonia, dysphagia and nasal regurgitation related to.Clinical symptoms include difficulty swallowing, slurred speech, facial pain, vertigo, Horner syndrome, and possibly palatal myoclonus.loss of pain and temperature sensation on the ipsilateral (same) side of the face.Sensory deficits affecting the face and cranial nerves on the same side with the infarct.loss of pain and temperature sensation on the contralateral (opposite) side of the body.Sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction.Constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain.Wallenberg syndrome = Lateral medullary syndrome (aka 'PICA' syndrome Posterior Inferior Cerebellar Artery syndrome) Return to: Unilateral Laryngeal Paralysis or Vocal Cord Paralysis see: Tapia Syndrome paralysis of vagus and hypoglossal nerves after intubation Wallenberg Syndrome (PICA Syndrome or Lateral Medullary Infaction)

Wallenburg pica syndrome step 1