Wallenberg’s Syndrome: A Case Illustration

Dear Editor, I hereby present a brief overview of Wallenberg's syndrome, a rare vascular brainstem syndrome with a case illustration, underscoring the significance of neuroimaging. A 57-year-old male with a medical history of diabetes, hypertension, and dyslipidemia presented with a sudden loss of balance and inability to walk. Vitals were stable. Neurological examination showed normal motor function, bilateral flexor plantar reflexes, and ataxic gait with leftward sway. Cerebellar signs were left sided, predominantly affecting the upper limb. Magnetic resonance imaging (MRI) detected restricted diffusion in the left lateral medulla oblongata, consistent with acute infarct Figure 1. Magnetic resonance angiography revealed no significant stenosis. The patient was conservatively treated with dual antiplatelets, statins, antihypertensives, and oral hypoglycemic agents.Subsequently, the patient improved clinically and was discharged.Figure 1: Axial section of the diffusion-weighted image reveals a focus of restricted diffusion in the left lateral medulla (indicated by the white arrow), consistent with an acute infarct.Wallenberg's syndrome, or lateral medullary syndrome, results from the infarction of the lateral medulla, affecting the inferior cerebellar peduncle, vestibular nuclei, and nucleus ambiguous.1,2 This distinctive stroke syndrome, named after the pioneering German neurologist Adolf Wallenberg in 1895, is characterized by classical features including ipsilateral hemiataxia, bulbar muscle weakness, hemifacial sensory loss, and Horner's syndrome.1 Typically, it is associated with atherothrombotic or embolic occlusion of the vertebral or posterior inferior cerebellar artery, and it generally carries a favorable prognosis.3 Atypical variants include: Millard–Gubler syndrome: Presents with ipsilateral Abducent and facial nerve palsy, and contralateral hemiplegia. Avellis syndrome: Involves the tegmentum of the medulla, manifesting with vagal nerve palsy and Horner's syndrome. Jackson syndrome: Features tegmental medullary involvement, resulting in vagal and hypoglossal palsy along with contralateral hemiplegia. Tapia syndrome: Characterized by hypoglossal palsy and extracranial recurrent laryngeal nerve palsy.4,5 Diagnosing Wallenberg's syndrome involves a thorough clinical examination, often complemented by neuroimaging studies. MRI is particularly useful in visualizing ischemic lesions in the medulla oblongata.5 The management of Wallenberg's syndrome is largely supportive and depends on the underlying cause.5 Acute interventions may include antiplatelet or anticoagulant therapy to prevent further ischemic events. Rehabilitation strategies, including physical therapy and speech therapy, play a crucial role in helping patients recover lost functions and improve their quality of life. Management of associated symptoms, such as vertigo and dysphagia, may require targeted interventions, including medications and specialized therapies. Diagnosis requires a meticulous neurological examination and strong clinical suspicion, as radiological features may be overlooked in routine neuroimaging. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.