Description, Causes and Risk Factors:
Wallenbergs disease is one of the most common clinically recognized conditions, which was first reported in 1895 and localized to lateral medulla supplied by the posterior inferior cerebellar artery (PICA). The Wallenberg syndrome is a rare syndrome involving part of the medulla oblongata with consequent cross-loss of pain and temperature sensation in the ipsilateral orofacial region and counterlateral body, loss of taste, and palatal palsy and loss of gag reflex, together with Horner's syndrome and ataxia, and relatively rarely with persistent obstinate singultus and cerebral cardiac syndrome. In the majority of cases Wallenberg syndrome is caused by an arteriosclerotic-thrombotic occlusion of the homolateral intracranial vertebral artery or posterior inferior cerebellar artery.
Wallenberg's syndrome is a neurological condition often caused by a stroke in the vertebral or posterior inferior cerebellar artery of the brain stem. Wallenberg's syndrome is commonly caused by thrombosis or embolism of the VA (vertebral artery) or PICA (posterior-inferior cerebellar artery). The stroke occurs in the medulla and cerebellum. The medulla controls such important functions as swallowing, speech articulation, taste, breathing, strength, and sensation. The cerebellum is important for coordination. The blood supply to these areas is via a pair of vertebral arteries and its branch, called the posterior inferior cerebellar artery (PICA).
Initially, the PICA was thought to be the blocked major artery, but this has been disproved from autopsy studies. In eight out of 10 cases, it is the vertebral artery that is occluded due to plaque buildup or because of a clot traveling from the heart. In younger patients, the vertebral artery dissection causes the infarct. The area of the stroke is only about 0.39 in (1 cm) vertically in the lateral part of the medulla and does not cross the midline.
Fully 50% of patients report transient neurological symptoms for several weeks preceding the stroke. During the first 48 hours after the stroke, the neurological deficit progresses and fluctuates. Dizziness, vertigo, facial pain, double vision, and difficulty walking are the most common initial symptoms. The facial pain can be quite bizarre with sharp jabs or jolts around the eye, ear, and forehead. Patients feel "seasick" or "off-balance" with nausea and vomiting. Objects appear double, tilted, or swaying. Along with gait imbalance, it becomes nearly impossible for the patient to walk despite good muscle strength. Other symptoms include hoarse voice, slurred speech, loss of taste, difficulty swallowing, hiccups, and altered sensation in the limbs of the opposite side.
The eye on the affected side has a droopy eyelid and a small pupil. The eyes jiggle when the person moves around; this is called nystagmus. There is decreased pain and temperature perception on the same side of the face. The limbs on the opposite side show decreased sensory perception. Voluntary movements of the arm on the affected side are clumsy. Gait is "drunken," and patients lurch and veer to one side.
The outlook for someone with Wallenberg's syndrome depends upon the size and location of the area of the brain stem damaged by the stroke. Some individuals may see a decrease in their symptoms within weeks or months. Others may be left with significant neurological disabilities for years after the initial symptoms appeared.
Symptoms include difficulties with swallowing, hoarseness, dizziness, nausea and vomiting, rapid involuntary movements of the eyes (nystagmus), and problems with balance and gait coordination. Some individuals will experience a lack of pain and temperature sensation on only one side of the face, or a pattern of symptoms on opposite sides of the body - such as paralysis or numbness in the right side of the face, with weak or numb limbs on the left side. Uncontrollable hiccups may also occur, and some individuals will lose their sense of taste on one side of the tongue, while preserving taste sensations on the other side. Some people with Wallenberg's syndrome report that the world seems to be tilted in an unsettling way, which makes it difficult to keep their balance when they walk.
Accurate diagnosis usually requires the expertise of a neurologist or a stroke specialist. It is common for an inexperienced physician to dismiss the symptoms of nausea, vomiting, and vertigo as being caused by an ear infection or viral illness. Diagnosis requires a thorough physical exam and neuroimaging. CT scans are insensitive and can detect only a large stroke or bleed in the cerebellum. Magnetic resonance imaging (MRI) scans are far superior, with the stroke showing up as a tiny bright spot in the medulla.
The treatment of Wallenberg's syndrome depends entirely on the symptoms that are associated with it. If the patient has problems swallowing, a feeding tube may be required for him to eat. And for such, a clinical speech or swallowing therapy is going to be beneficial.
As for the pains brought about by the Wallenberg's syndrome, certain drugs are prescribed to cure it or at least reduce its severity. The pains are usually referred as chronic pains because of their recurring nature. And anti-epileptic drugs like gabapentin treat them.
People with Wallenberg's syndrome experience recovery from the disease while undergoing therapy sessions. Some patients feel that the symptoms of this disease start to dissipate after several weeks of treatment. But it all depends as to how much the syndrome had accelerated in them and how effective the medical therapy their doctor has prescribed.
Wallenberg's syndrome is a type of stroke. And most of its complications depend upon the location and the mass of the brain stem damage the body had sustained. The decrease in symptoms would happen only after a week or even months of treatment and therapy. Take note that relief from symptoms won't happen immediately.
It is then important for patients to follow religiously what their doctors had planned out from them. This would take patients to recovery or at least, problems like neurological disabilities are can be ruled out.
And right now, several researches are being done to fully treat, and eventually to prevent the disease. Currently, all treatments are directed only to address the symptoms. The patients' full recovery from the disease is still pending research. The National Institute of Neurological Disorders and Stroke or simply the NINDS is the one in charge of the advanced studies conducted towards the eradication of the Wallenberg's syndrome.
NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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