Wallenberg's Lateral Medullary Syndrome: Clinical-Magnetic Resonance Imaging Correlations

doi:10.1001/archneur.1993.00540060049016

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Vol. 50 No. 6, June 1993

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Wallenberg's Lateral Medullary Syndrome

Clinical-Magnetic Resonance Imaging Correlations

Ralph L. Sacco, MD; Lorenza Freddo, MD; Jacqueline A. Bello, MD; Jeffrey G. Odel, MD; Stephen T. Onesti, MD; J. P. Mohr, MD

Arch Neurol. 1993;50(6):609-614.

Abstract

• Objective.
—To correlate clinical and radiologic findings in patientswith lateral medullary infarction.

Design.
—Case series with "blinded" evaluation of brain imaging.

Setting.
—Hospitalized and ambulatory patients at the NeurologicalInstitute of New York (NY).

Patients.
—Thirty-three consecutive patients with lateral medullarysyndrome were evaluated by the Stroke Center between 1983 and1989.

Results.
—Ataxia (70%), numbness either of the ipsilateral faceor of the contralateral body (64%), vertigo (51 %), and dysphagia(51%) were the most frequent symptoms at onset. Eleven patientshad ocular symptoms (diplopia or blurred vision). Horner's syndromewas found in 91 %, ipsilateral ataxia in 85%, and contralateralhypalgesia in 85%. Nystagmus (61%) and facial weakness (42%)were less frequent. Head computed tomography was abnormal onlywhen a cerebellar infarction was present (three cases). Magneticresonance imaging, obtained in 22 cases, was normal in two;a lateral medullary infarction alone was present in 12, anda lesion extending beyond the lateral medulla was found in eight.No correlation was noted between facial weakness or ocular symptomsand infarction extending beyond the lateral medullary region.Vertebral artery disease was confirmed by vascular imaging orinsonation studies in 73% of patients.

Conclusions.
—The triad of Horner's syndrome, ipsilateral ataxia, andcontralateral hypalgesia will clinically identify patients withlateral medullary infarction. Facial weakness and ocular symptomsare frequent and do not necessarily imply that the infarctionextends beyond the lateral medulla. Cerebellar infarcts onlyinfrequently accompany lateral medullary syndrome, suggestingthat most of the posterior inferior cerebellar artery territoryis spared, despite the high frequency of vertebral artery occlusion.

Author Affiliations

From the Departments of Neurology (Drs Sacco, Freddo, Onesti, and Mohr), Neuroradiology (Dr Bello), and Ophthalmology (Dr Odel), Columbia Presbyterian Medical Center, New York, NY.

Footnotes

Accepted for publication October 6, 1992.

Presented in part at the 114th Annual Meeting of the AmericanNeurological Association, New Orleans, La, September 26, 1989.

Reprint requests to Neurological Institute, Stroke Service,710 W 168th St, New York, NY 10032 (Dr Sacco).

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