Lateral medullary syndrome

Lateral medullary syndrome
The three major arteries of the cerebellum: the SCA, AICA, and PICA. (Posterior inferior cerebellar artery is PICA.)
ICD-10	G46.3
DiseasesDB	10449
MeSH	D014854

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Wallenberg's syndrome; posterior inferior cerebellar artery syndrome (PICA)

Pathophysiology

Lateral medullary syndrome is basically a manifestation of vasoocclusive disease of intracranial vertebral artery (ICVA). The various pathophysiologic mechanisms involved can include atherosclerosis, athero-embolic phenomenon (heart, aorta, or vertebral arteries), dissection and increased vascular tortuosity. Involvement of various structures in lateral medulla along with respective manifestation or clinical signs include;

• Nucleus ambiguus: dysphagia, dysphonia and dysarthria, laryngeal, pharyngeal and palatal paralysis
• Trigeminal nucleus: ipsilateral facial and corneal anesthesia
• Spinothalamic tract: loss of pain and temperature sensation to the opposite side of body
• Crebellum: ataxia
• Hypothalamic fibers: sympathetic nervous system abnormal c/w Horners syndrome
• Deiters' nucleus and other vestibular nuclei: nystagmus and vertigo
• Central tegmental tract: palatal myoclonus
  

Causes

• Atherosclerosis
• Embolism
• Dissection
• Dolichoectasia

Diagnosis

Symptoms

Symptoms include:

• Ageusia or loss of taste on one side of the tongue
• Ataxia or incoordination
• Diplopia or double vision
• Oscillopsia
• Dizziness
• Dysphagia or difficulties with swallowing
• Dysphonia or hoarseness
• Dysarthria or slurred speech
• Facial pain
• Falling
• Palatal myoclonus
• Hiccups
• Hoarseness
• Impaired gait
• Impaired coordination
• Bilateral leg weakness
• Hemiparesis
• Numbness
• Hypesthesia or lack of pain and temperature sensation on only one side of the face
• Nystagmus or rapid involuntary movements of the eyes
• Nausea and vomiting
• Vertigo

Physical Examination

Neurologic

• Contralateral sensory deficits (pain and temperature sensation) affecting the trunk and extremities
• Ipsilateral sensory deficits (pain and temperature sensation) affecting the face and cranial nerves
  • absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex (Damage to the spinal trigeminal nucleus)
• Ataxia
• Nystagmus,
• Horner's syndrome
• Ipsilateral vocal fold paralysis
• Palatal and pharyngeal paresis

MRI

Clinical B1000 diffusion weighted MRI image showing an acute left sided dorsal lateral medullary infarct

Localization of the Lesion

Dysfunction	Effects
lateral spinothalamic tract	contralateral deficits in pain and temperature sensation from body
spinal trigeminal nucleus	ipsilateral loss of pain and temperature sensation from face
nucleus ambiguus (which affects vagus X and glossopharyngeal nerves IX)	dysphagia, hoarseness, diminished gag reflex
vestibular system	vertigo, diplopia, nystagmus, vomiting
descending sympathetic fibers	ipsilateral Horner's syndrome
central tegmental tract	palatal myoclonus

External links

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