wallenberg syndrome

Wallenberg's syndrome, also called "lateral bulbous dimple syndrome", is a set of signs that may suggest a possible stroke located in the spinal cord and cerebellum. These nervous structures controlling many functions, such as balance, coordination of movements, swallowing or speech, the symptoms can be very varied. This stroke, like all the others, must be treated quickly. The prognosis depends on the age of the patient and the extent of the lesions.

Wallenberg's syndrome causes

The brainstem is the part of the central nervous system located at the base of the skull. It is located between the brain and the spinal cord. It includes the elongated medulla, the bridge and the midbrain. Placed in front of the cerebellum, the brainstem is the place where most of the cranial nerves emerge. These nerve structures govern many functions of the body. The cerebellum, for example, manages gesture coordination or balance. The cranial nerves control the movements of the face.

The brainstem is richly vascularized, in particular by:

• the vertebral artery.
• the cerebral artery (which is a collateral branch of the vertebral artery).
• the basilar artery (which arises from the union of the vertebral arteries).

Wallenberg's syndrome origins 

Wallenberg syndrome is due to a narrowing (stenosis) or a stop in the perfusion of one or more of the arteries supplying the brainstem. This stoppage can be the consequence of the presence of an obstacle obstructing the artery, partially or completely, or the result of a section of the artery, situations caused by:

• the formation of atheroma plaques (cholesterol) stiffening and reducing the diameter of the vessels.
• a cardiac embolism (clot formation).
• a trauma.
• cocaine use (a strong vasoconstrictor).
• a malformation or tumor.

Wallenberg syndrome symptoms

The signs of Wallenberg syndrome are mainly linked to the number of arteries affected and the extent of the area concerned. However, there are generally very characteristic symptoms such as:

• severe, sudden onset headache.
• balance, coordination and gait disturbances.
• phonic disorders such as speech difficulties, dysphonia or persistent hiccups.
• swallowing disorders.
• facial paralysis.

Wallenberg syndrome treatments

Three levels of care can be considered.

Emergency treatment

The earliest treatment is to take blood thinners to reduce a possible blood clot. If Wallenberg syndrome is due to the rupture of a vessel causing hemorrhage, management may be neurosurgical. Analgesics are administered to relieve severe pain.

Re-education

Rehabilitation must start as quickly as possible so that the patient can recover the maximum of his capacities. This recovery, if it is a function of the patient's age and the degree of involvement, can sometimes be spectacular in some cases. Thus, multidisciplinary care (neurologist, speech therapist ...) must be implemented quickly.

Prevention

Prevention consists of once again avoiding too much deposition of atheroma plaques. For this, the patient is generally placed on cholesterol-lowering drugs. If his blood pressure is too high, an antihypertensive agent will complement it. The patient will of course be invited to reduce the risk factors for recurrence, such as alcohol, tobacco, stressful situations or sedentary lifestyle. Dietary support can be considered.