Do Not Dismiss the Dizzy Patient: A Case of Wallenberg Syndrome Highlighting Red Flags for Central Vertigo in Primary Care

Background Wallenberg syndrome, or lateral medullary syndrome, is a type of posterior circulation stroke that is often mistaken for peripheral vestibular disease because there is no muscle weakness. Family practitioners and emergency doctors should be aware of the key signs to prevent diagnostic errors. Case Description A 70-year-old man with coronary artery disease, heart failure with reduced EF, hypertension, and hyperlipidemia who came into a Houston area ED with vertigo, right-sided facial paresthesias, difficulty swallowing, and imbalance. The first set of CT and MRIs was interpreted as normal; however, a neurology-directed reassessment led to the diagnosis of an acute non-hemorrhagic infarct involving the dorsolateral aspect of the right medulla and a thrombosis of the right vertebral artery. His treatment included dual antiplatelet therapy and statins, as well as physiotherapy. Discussion The case highlights three key learning points for general medicine: (1) ipsilateral cranial nerve dysfunction, ataxia, and dysphagia along with vertigo serve as key red flags necessitating immediate MRI scanning despite CT results; (2) HINTS is an evidence-based method of differentiating between central and peripheral vertigo at the bedside; and (3) lack of adequate control over cardiovascular risk factors, represented by an LDL level of 139 mg/dL and the absence of established general medical care, may have played a role in the etiology of the stroke. Conclusion Diagnosis of Wallenberg’s syndrome needs to be considered for any patients complaining of acute vertigo and other neurological symptoms. Family doctors are very important in controlling risk factors, organizing care after strokes, and recognizing central vertigo syndromes.