Wallenberg's lateral medullary syndrome. Clinical-magnetic resonance imaging correlations

R. L. Sacco, L. Freddo, J. A. Bello, J. G. Odel, S. T. Onesti and J. P. Mohr
Department of Neurology, Columbia Presbyterian Medical Center, New York, NY.

OBJECTIVE--To correlate clinical and radiologic findings in patients with lateral medullary infarction. DESIGN--Case series with "blinded" evaluation of brain imaging. SETTING--Hospitalized and ambulatory patients at the Neurological Institute of New York (NY). PATIENTS--Thirty-three consecutive patients with lateral medullary syndrome were evaluated by the Stroke Center between 1983 and 1989. RESULTS--Ataxia (70%), numbness either of the ipsilateral face or of the contralateral body (64%), vertigo (51%), and dysphagia (51%) were the most frequent symptoms at onset. Eleven patients had ocular symptoms (diplopia or blurred vision). Horner's syndrome was found in 91%, ipsilateral ataxia in 85%, and contralateral hypalgesia in 85%. Nystagmus (61%) and facial weakness (42%) were less frequent. Head computed tomography was abnormal only when a cerebellar infarction was present (three cases). Magnetic resonance imaging, obtained in 22 cases, was normal in two; a lateral medullary infarction alone was present in 12, and a lesion extending beyond the lateral medulla was found in eight. No correlation was noted between facial weakness or ocular symptoms and infarction extending beyond the lateral medullary region. Vertebral artery disease was confirmed by vascular imaging or insonation studies in 73% of patients. CONCLUSIONS--The triad of Horner's syndrome, ipsilateral ataxia, and contralateral hypalgesia will clinically identify patients with lateral medullary infarction. Facial weakness and ocular symptoms are frequent and do not necessarily imply that the infarction extends beyond the lateral medulla. Cerebellar infarcts only infrequently accompany lateral medullary syndrome, suggesting that most of the posterior inferior cerebellar artery territory is spared, despite the high frequency of vertebral artery occlusion.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Neuroimaging Strategies for Three Types of Horner Syndrome with Emphasis on Anatomic Location
Lee et al.
Am. J. Roentgenol. 2007;188:W74-W81.
ABSTRACT | FULL TEXT  

Pontomedullary sulcus infarct: a variant of lateral medullary syndrome.
Vuillier et al.
J. Neurol. Neurosurg. Psychiatry 2006;77:1276-1278.
ABSTRACT | FULL TEXT  

Left-hemispheric dominance for articulation: a prospective study on acute ischaemic dysarthria at different localizations
Urban et al.
Brain 2006;129:767-777.
ABSTRACT | FULL TEXT  

Lesional location of lateral medullary infarction presenting hiccups (singultus)
Park et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:95-98.
ABSTRACT | FULL TEXT  

Lateral and Medial Medullary Infarction: A Comparative Analysis of 214 Patients
Kameda et al.
Stroke 2004;35:694-699.
ABSTRACT | FULL TEXT  

Topodiagnostic investigations on the sympathoexcitatory brain stem pathway using a new method of three dimensional brain stem mapping
Marx et al.
J. Neurol. Neurosurg. Psychiatry 2004;75:250-255.
ABSTRACT | FULL TEXT  

Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients
Kim
Brain 2003;126:1864-1872.
ABSTRACT | FULL TEXT  

Cerebellar Speech Representation: Lesion Topography in Dysarthria as Derived From Cerebellar Ischemia and Functional Magnetic Resonance Imaging
Urban et al.
Arch Neurol 2003;60:965-972.
ABSTRACT | FULL TEXT  

Emotional facial paresis in a patient with a lateral medullary infarction
Cerrato et al.
Neurology 2003;60:723-724.
FULL TEXT  

Lateral Medullary Syndrome After Prone Position for General Surgery
Chu et al.
Anesth. Analg. 2002;95:1451-1453.
ABSTRACT | FULL TEXT  

The course of corticofacial projections in the human brainstem
Urban et al.
Brain 2001;124:1866-1876.
ABSTRACT | FULL TEXT  

Dysphagia in Lateral Medullary Infarction (Wallenberg's Syndrome): An Acute Disconnection Syndrome in Premotor Neurons Related to Swallowing Activity?
Aydogdu et al.
Stroke 2001;32:2081-2087.
ABSTRACT | FULL TEXT  

Dysarthria in acute ischemic stroke: Lesion topography, clinicoradiologic correlation, and etiology
Urban et al.
Neurology 2001;56:1021-1027.
ABSTRACT | FULL TEXT  

Restricted Dissociated Sensory Loss in a Patient With a Lateral Medullary Syndrome : A Clinical-MRI Study
Cerrato et al.
Stroke 2000;31:3064-3066.
ABSTRACT | FULL TEXT  

Course and distribution of facial corticobulbar tract fibres in the lower brain stem
Terao et al.
J. Neurol. Neurosurg. Psychiatry 2000;69:262-265.
ABSTRACT | FULL TEXT  

Wallenberg's syndrome
PEARCE
J. Neurol. Neurosurg. Psychiatry 2000;68:570-570.
FULL TEXT  

Aspiration Subsequent to a Pure Medullary Infarction: Lesion Sites, Clinical Variables, and Outcome
Kim et al.
Arch Neurol 2000;57:478-483.
ABSTRACT | FULL TEXT  

Central Causes of Dizziness
Furman and Whitney
ptjournal 2000;80:179-187.
FULL TEXT  

Sensory Sequelae of Medullary Infarction : Differences Between Lateral and Medial Medullary Syndrome
Kim and Choi-Kwon
Stroke 1999;30:2697-2703.
ABSTRACT | FULL TEXT  

Blink reflex R2 changes and localisation of lesions in the lower brainstem (Wallenberg's syndrome): an electrophysiological and MRI study
Fitzek et al.
J. Neurol. Neurosurg. Psychiatry 1999;67:630-636.
ABSTRACT | FULL TEXT  

Dorsolateral infarction of the lower medulla: Clinical- MRI study
Brochier et al.
Neurology 1999;52:190-190.
ABSTRACT | FULL TEXT  

Patterns of Lateral Medullary Infarction : Vascular Lesion–Magnetic Resonance Imaging Correlation of 34 Cases
Kim et al.
Stroke 1998;29:645-652.
ABSTRACT | FULL TEXT  

Central facial weakness due to medial medullary infarction: the course of facial corticobulbar fibres
Terao et al.
J. Neurol. Neurosurg. Psychiatry 1997;63:391-393.
ABSTRACT | FULL TEXT  

Late Contralateral Hyperhidrosis in Lateral Medullary Infarcts
Rousseaux et al.
Stroke 1996;27:991-995.
ABSTRACT | FULL TEXT  

Discriminative Sensory Dysfunction After Unilateral Stroke
Kim and Choi-Kwon
Stroke 1996;27:677-682.
ABSTRACT | FULL TEXT  

Sensory Changes in the Ipsilateral Extremity : A Clinical Variant of Lateral Medullary Infarction
Kim et al.
Stroke 1995;26:1956-1958.
ABSTRACT | FULL TEXT  

Medial Medullary Syndrome : Report of 18 New Patients and a Review of the Literature
Kim et al.
Stroke 1995;26:1548-1552.
ABSTRACT | FULL TEXT  

Cerebral Blood Flow in Lateral Medullary Infarcts
Rousseaux et al.
Stroke 1995;26:1404-1408.
ABSTRACT | FULL TEXT  

Contralateral Hyperhidrosis After Cerebral Infarction : Clinicoanatomic Correlations in Five Cases
Kim et al.
Stroke 1995;26:896-899.
ABSTRACT | FULL TEXT