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Wallenberg’s syndrome: Symptoms, causes, and treatment

Wallenberg’s syndrome, or lateral medullary syndrome as it is known medically, is a condition affecting the central nervous system. It is often caused by a stroke occurring in the brain stem, specifically in the lateral aspect of the medulla.

When oxygen-rich blood cannot reach parts of the brain stem due to a stroke or other condition, many symptoms can occur.

Some people may be more at risk for Wallenberg’s syndrome than others, though this is not straightforward.

Treatment typically involves reducing or improving symptoms. The long-term outlook for people with Wallenberg’s syndrome can vary greatly.

Contents of this article:

  1. Symptoms
  2. Causes and risk factors
  3. Diagnosis
  4. Treatment
  5. Research and support
  6. Outlook

Symptoms

diagram of the brain stem
The brain stem connects the brain to the rest of the body.

The brain stem is made up of several parts and connects the brain to the rest of the body, and it controls the flow of messages and chemical signals between these two areas.

The brain stem affects basic body functions, such as swallowing, breathing, and heart rate. It even controls consciousness, and how awake or asleep a person feels.

A lack of blood flow and oxygen in the brain stem can cause serious problems throughout the body, including Wallenberg’s syndrome.

A common symptom among people who have Wallenberg’s syndrome is difficulty swallowing. Some people may not be able to swallow at all.

It may also cause problems with how the muscles respond to the brain’s commands. A person may have difficulty with perceiving certain senses because of this, especially their sense of touch.

Other symptoms of Wallenberg’s syndrome can include:

  • difficulty breathing
  • difficulty speaking
  • severe, persistent hiccups
  • nausea
  • vomiting
  • headache
  • hoarseness in the voice
  • rapid eye movements in many directions
  • dizziness or vertigo
  • falling and trouble with balance
  • fluctuations in body temperature sensations, such as hot flashes or chills
  • reduced sweating

Wallenberg’s syndrome can also cause more unusual symptoms in the body. Some people may experience neurological changes in one side of their body, such as feeling colder on one side.

People may feel pain, stinging, or complete numbness on one side of their body as well. This sensation can occur all over the body but is more common in areas, such as the arms, legs, and face.

Some people report feeling that the world around them is off balance or things are tilting towards one side of the room. Some people may experience drastic changes in their heart rate or blood pressure.

Individuals who experience any or all of these symptoms should discuss them with a doctor if their cause is not known. They may be a sign of Wallenberg’s syndrome or another serious disorder.

Causes and risk factors

Wallenberg’s syndrome is usually caused by a stroke, which occurs when blood flow to an area in the back of the brain is cut off. This causes the affected cells and nerves to die due to lack of oxygen. These dying brain cells and nerves cause symptoms in the areas they control.

Older lady being examined by a GP
Head and neck injuries may be a cause of Wallenberg’s syndrome.

The symptoms can also be caused or influenced by many other disorders, including:

  • cancer
  • head or neck injuries
  • aneurysm
  • inflammation of the wall of the artery in the neck
  • hematoma, or an abnormal blood clot
  • brain stem encephalitis due to herpes
  • multiple sclerosis
  • brain stem tuberculoma, which is a rare form of tuberculosis
  • certain infections, such as varicella infection

Some people may be more at risk for Wallenberg’s syndrome than others, though it is still unknown exactly why this type of damage occurs.

There may be a connection between certain conditions and the symptoms of Wallenberg’s syndrome. People who have a history of blood clots, heart disease, smoking, pregnancy, recent delivery, and circulation problems may be more at risk. Head and neck injuries may also be a contributing factor in some people.

Other disorders such as multiple sclerosis, herpes, and cancer may put a person at greater risk for Wallenberg’s syndrome as well.

Diagnosis

Wallenberg’s syndrome may seem easy to identify, but doctors will want to be certain that they are not confusing symptoms with those of another disorder.

Doctors will listen to the individual describe their symptoms and will review their health and medical history before moving forward. The doctor will perform a thorough neurological examination and will likely want to carry out some form of imaging test.

Taking images of the brain stem and evaluating blood flow using a CT scan or MRI (magnetic resonance imaging) helps identify if someone’s lateral aspect of the medulla is affected. These imaging tests provide an accurate view inside the body, making it easier to identify a block in the arteries and damage to the brain stem.

Treatment

speech therapy
Speech therapy may be recommended if there are issues with mouth and tongue movement.

There is no simple cure for Wallenberg’s syndrome.

The aim of treatment is to minimize symptoms as much as possible while managing the ones that cannot be resolved. Understanding the cause of the symptoms is a necessary step in treatment.

Therapy and rehabilitation are important aspects of treating Wallenberg’s syndrome. Doctors may refer the person to a speech therapist if they are having difficulty moving their mouth and tongue or problems swallowing.

In severe situations where patients are unable to swallow, a feeding tube may be necessary as well as swallowing therapy.

Doctors are likely to prescribe medication for certain symptoms. If a clot-forming stroke caused the symptoms, doctors may prescribe blood thinners to help break up or dissolve any blockage in the artery that has caused the damage. Blood thinners may also reduce the risk of blood clots forming in the future.

Doctors may recommend that a person with Wallenberg syndrome take a low dose of a drug such as aspirin for the rest of their lives to reduce the chances of another stroke.

Doctors may also prescribe pain management medications to help treat long-lasting pain. Some people may benefit from taking anti-seizure, anti-convulsant, or anti-epileptic drugs.

One of the more difficult symptoms to treat is persistent hiccups, which many people with Wallenberg’s syndrome experience. These hiccups can be violent and painful at times and may make it difficult for a person to eat, speak, or even sleep.

The hiccups may last for days or weeks at a time. A muscle relaxer called baclofen may be beneficial in helping patients with chronic hiccups, but treatment can be difficult.

Research and support

There is a network of groups working to research Wallenberg’s syndrome and provide support for those who have it.

The National Institute of Neurological Disorders and Stroke (NINDS) carries out research on Wallenberg’s syndrome and supports additional research through other institutions. The goal of this research is to find better ways to prevent or treat these symptoms while looking for a cure, if there is one, depending on the cause.

Other organizations that support research and outreach for Wallenberg’s syndrome include:

  • National Stroke Association
  • American Heart Association
  • National Rehabilitation Information Center (NARIC)

Knowledge gained from any website will not replace the benefit of working directly with an experienced doctor and therapy team toward treatment goals.

 

 

SOURCE:

medicalnewsday

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