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Colegio de Medicina Interna de México.

2024, Number 7

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Med Int Mex 2024; 40 (7)

Wallenberg syndrome associated with spontaneous vertebral dissection

Hernández VLA, de Lera AM

Language: Spanish
References: 16
Page: 445-451
PDF size: 269.14 Kb.


ABSTRACT

Background: Wallenberg syndrome is caused by infarction of the lateral and posterior portion of the inferior olivary nucleus of the medulla oblongata. Its diagnosis is usually a challenge, since it frequently manifests with non-specific symptoms or that overlap with a stroke of the anterior circulation.
Clinical case: A 48-year-old male patient, with no personal history of interest, who consulted for vertigo and instability. On examination he presented: left Horner’s syndrome, slight drooping of the left palate, left facial palsy, ataxia, left lateropulsion, hypoesthesia in the right hemibody. Cover test, cephalic imposed and HINTS test were negative. A computed tomography (CT) scan of the brain showed no alterations, and angio-CT of the supra-aortic trunks and circle of Willis showed loss of flow density of the left vertebral artery in its V3 and V4 segments. Subsequently, in brain magnetic resonance image (MRI) and MRI-angiography of the supra-aortic trunks and circle of Willis, acute infarct foci were observed in the left lateral region of the medulla oblongata and posterior and inferomedial region of the left cerebellar hemisphere, filiform flow in the left V3 and V4 segments.
Conclusions: Vertebral artery dissection is an important cause to consider and should be suspected in young patients.


REFERENCES

  1. Gasca-González OO, Pérez-Cruz JC, Baldoncini M, Macías-Duvignau MA, Delgado-Reyes L. Bases neuroanatómicasdel síndrome de Wallenberg. Cir Cir 2020; 88(3): 376-82.DOI: https://doi.org/10.24875/CIRU.19000801

  2. Schulz UG, Fischer U. Posterior circulation cerebrovascularsyndromes: diagnosis and management. J NeurolNeurosurg Psychiatry 2017; 88(1): 45-53. DOI: https://doi.org/10.1136/jnnp-2015-311299

  3. Keser Z, Chiang CC, Benson JC, Pezzini A, Lanzino G. CervicalArtery Dissections: Etiopathogenesis and Management.Vasc Health Risk Manag 2022; 18: 685-700. DOI: https://doi.org/10.2147/VHRM.S362844

  4. Salerno A, Strambo D, Nannoni S, Dunet V, Michel P. Patternsof ischemic posterior circulation strokes: A clinical, anatomical,and radiological review. Int J Stroke 2022; 17(7): 714-22. DOI: https://doi.org/10.1177/17474930211046758

  5. Merwick Á, Werring D. Posterior circulation ischaemicstroke. BMJ. 2014; 348: g3175. DOI: https://doi.org/10.1136/bmj.g3175

  6. Alet MJ, Pujol Lereis V, Ameriso SF, Lemme-Plaghos L. Accidentecerebrovascular bulbar lateral con trayecto extracranealde la arteria cerebelosa póstero-inferior. Medicina(B Aires). 2018; 78(5): 364-7

  7. Sciacca S, Lynch J, Davagnanam I, Barker R. Midbrain,Pons, and Medulla: Anatomy and Syndromes. Radiographics2019; 39(4): 1110-25. DOI: https://doi.org/10.1148/rg.2019180126

  8. Zürcher E, Richoz B, Faouzi M, Michel P. Differences in IschemicAnterior and Posterior Circulation Strokes: A Clinico-Radiological and Outcome Analysis. J Stroke CerebrovascDis 2019; 28(3): 710-8. DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2018.11.016

  9. Sparaco M, Ciolli L, Zini A. Posterior circulation ischemicstroke-a review part II: imaging and acute treatment.Neurol Sci 2019; 40(10): 2007-15. DOI: https://doi.org/10.1007/s10072-019-03936-x

  10. Sparaco M, Ciolli L, Zini A. Posterior circulation ischaemicstroke-a review part I: anatomy, aetiology and clinicalpresentations. Neurol Sci 2019; 40(10): 1995-2006. DOI:https://doi.org/10.1007/s10072-019-03977-2

  11. Lui F, Tadi P, Anilkumar AC. Wallenberg Syndrome. TreasureIsland (FL): StatPearls Publishing; 2023. DirecciónURL: https://www.ncbi.nlm.nih.gov/books/NBK470174/(Consulta: Junio, 2023)

  12. Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ,Schroth G. Basilar artery occlusion. Lancet Neurol 2011;10(11): 1002-14. DOI: https://doi.org/10.1016/S1474-4422(11)70229-0

  13. Chakor RT, Eklare N. Vertigo in Cerebrovascular diseases.Int J Otorhinolaryngol Clin 2012; 4(1): 46-53. DOI: https://doi.org/10.5005/jp-journals-10003-1087

  14. Piechowski-Jóźwiak B, Bogousslavsky J. Posterior circulationstrokes. Handb Clin Neurol 2009; 93: 537-58. DOI:https://doi.org/10.1016/S0072-9752(08)93026-8

  15. Evangelidou E, Dengler R. Akute Hirnstammsyndrome[Acute brain stem syndromes]. Nervenarzt 2009; 80(8):975-86. DOI: https://doi.org/10.1007/s00115-008-2608-x

  16. Querol-Pascual MR. Clinical approach to brainstem lesions.Semin Ultrasound CT MR 2010; 31(3): 220-9. DOI: https://doi.org/10.1053/j.sult.2010.03.004




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