In Wallenberg syndrome, the vertebral artery or the posterior inferior cerebellar artery become blocked. The disease is synonymously referred to as Wallenberg-Foix syndrome or Viesseaux-Wallenberg. As a result, infarction occurs in a specific area of the brain stem called the dorsolateral medulla oblongata. Basically, it is a rare type of stroke.
What is Wallenberg Syndrome?
In principle, Wallenberg syndrome is a brainstem syndrome, specifically a so-called alternans syndrome. For definitions of melorheostosis, please visit lawfaqs.net.
In the context of Wallenberg syndrome, there are a variety of symptoms that depend on the neurological areas that are affected.
Wallenberg syndrome was first mentioned in 1808 by Gaspard Vieusseux.
However, it was named after the doctor Adolf Wallenberg. He first described Wallenberg syndrome in 1895. In 1901, the first diagnosis of the disease was made by autopsy.
Causes
The primary cause for the development of Wallenberg syndrome is primarily ischemia affecting the area of the vertebral artery. As a result, the posterior inferior cerebellar artery closes. In addition, the dorsolateral medulla oblongata and certain areas of the cerebellum are infarcted.
This damages special pathways in the spinal cord. Certain core areas, such as those of the statoacoustic nerve and the vagus nerve, are also affected. In addition to a blockage of the arteries, there can be a severe narrowing of the blood vessels. The branches of the respective arteries may also be affected.
Some of these branches are responsible for supplying the medulla oblongata. The result is an infarction of the lateral extended cord. This leads to characteristic failure phenomena. Basically, in the majority of cases, the vertebral artery is affected by Wallenberg syndrome.
Symptoms, Ailments & Signs
Wallenberg syndrome includes numerous characteristic symptoms. There are often ipsilateral signs, for example a reduced corneal reflex, disturbances in facial sensitivity or paralysis of the vocal cords. Horner syndrome, hemiataxia, and soft palate paresis are also possible.
In some cases, there are also dissociated disorders related to the perception of pain and temperature. However, these symptoms only appear on the body and not on the face. Some patients have a tendency to fall toward the affected side and complain of ipsilateral nystagmus.
If the nucleus spinalis nervi trigemini is impaired, the pain sensation on the ipsilateral side of the face is lost. The corneal reflex is greatly reduced or absent. If the spinothalamic tract is damaged, there is no perception of temperature or pain on the side of the body opposite the infarction.
Lesions of the cerebellum or inferior cerebellar crus usually result in ataxia. When the hypothalamospinal fibers are damaged, the sympathetic transmission of signals is impaired. As a result, the so-called Horner syndrome may occur.
If the Nucleus Deiter is affected, dizziness and eye tremors occur. Other possible symptoms of Wallenberg syndrome include hoarseness, hemiataxia, dysarthria, and hypacusis. In addition, trigeminal disorders are possible.
Diagnosis & course of disease
In order to diagnose Wallenberg syndrome, the first part of the examination involves taking the anamnesis. The attending doctor discusses the patient’s medical history with the sick patient. In the course of this, genetic burdens, certain pre-existing conditions, chronic diseases and the personal lifestyle of the person are analysed.
The anamnesis gives the doctor the first indications for the diagnosis. Various clinical examinations are then carried out. In particular, the typical symptoms of Wallenberg syndrome are clarified. If the affected patient suffers from several characteristic complaints, the suspicion of Wallenberg syndrome is confirmed.
The prognosis for Wallenberg syndrome is highly dependent on the location and size of the area damaged by the stroke. In some patients, the symptoms of Wallenberg syndrome subside after a few weeks or months by means of recanalization. However, in the majority of those affected, neurological symptoms and functional disorders are still evident after several years.
Complications
Wallenberg syndrome is a serious complaint that can lead to serious complications and limitations in the everyday life of those affected. The patients suffer from an infarction in the brain, resulting in sensory disturbances or paralysis in the face of the person concerned. This can also lead to swallowing difficulties, so that the patients can no longer easily take food and liquids and are therefore dependent on the help of other people in their everyday life.
A false sensitivity to temperature and pain can also develop in Wallenberg syndrome, which may prevent those affected from correctly recognizing danger. Speaking can also be negatively influenced by the syndrome, which can lead to severe difficulties, especially in children. Patients often suffer from eye tremors or permanent hoarseness. The quality of life of those affected is significantly restricted and reduced by Wallenberg syndrome.
The treatment of Wallenberg syndrome is always based on the symptoms, since no causal treatment is possible. There are no particular complications, and complete healing cannot be achieved. The syndrome often has a very negative effect on the quality of life of those affected and can promote mental health problems or even depression.
When should you go to the doctor?
Since Wallenberg’s syndrome cannot heal on its own, those affected by this disease definitely need to see a doctor. Early detection and treatment of this syndrome is the only way to prevent further complications and symptoms. Early detection always has a very positive effect on the further course of the disease. In the first place, attacks of dizziness indicate the disease. Those affected can no longer concentrate properly and also suffer from significant confusion. There can also be tremors in the eyes or severe hoarseness, which can indicate Wallenberg syndrome.
The perception of temperature changes significantly and pain appears in different parts of the body. If these symptoms occur for no particular reason and do not go away on their own, a doctor must be consulted in any case. In emergencies, an ambulance can be called or a hospital can be visited directly. The first diagnosis can be made by a general practitioner. It cannot be universally predicted whether Wallenberg syndrome will lead to a reduced life expectancy for those affected.
Treatment & Therapy
In principle, the treatment of Wallenberg syndrome is exclusively symptomatic. Difficulty swallowing sometimes requires the insertion of a nasogastric tube. Speech therapy treatment may also be prescribed to relieve difficulty swallowing and speaking.
Some medicines are also used to reduce pain. In this case, gabapentin is suitable for the treatment of chronic pain. Since the affected arteries are usually too small, surgical recanalization is usually not possible.
In the long term, prevention of further strokes is necessary. The corresponding measures are primarily based on the individual risk factors. For example, aspirin therapy is used to reduce the risk of another stroke.
Anticoagulants are necessary for atrial fibrillation. In some cases, other drugs are used, such as drugs used to treat high blood pressure. Lifestyle changes are also helpful for some patients.
Prevention
Statements regarding the prevention of Wallenberg syndrome are only possible to a limited extent. Because the disease cannot be prevented in every case. However, certain personal lifestyle factors play a role in the development of the disease. The health of the blood vessels and the cardiovascular system is particularly important here.
Aftercare
In most cases, the options for aftercare for Wallenberg syndrome are significantly limited and are often not available to the person affected. Therefore, the person affected by this disease should consult a doctor as early as possible and initiate treatment in order to prevent the occurrence of other symptoms and complications. Self-healing usually cannot occur.
Since Wallenberg syndrome is also a genetic disease, it can be inherited, so if you want to have children, genetic testing and counseling should primarily be carried out to prevent recurrence. As a rule, those affected by this disease are dependent on the measures of physiotherapy and physiotherapy to alleviate the symptoms.
The help and support of one’s own family in everyday life is also very important, as this can also prevent depression and other mental upsets. In many cases, contact with other people affected by the disease also proves to be very useful in order to find out how everyday life with the disease can be managed more easily. A general course of Wallenberg syndrome cannot be predicted.
You can do that yourself
Wallenberg syndrome requires individual therapy that depends on the symptoms of the stroke. Speech or swallowing therapy, for example, may be necessary in order to relearn skills that have been lost. These therapies can be supported at home by practicing independently.
The intake of drugs such as gabapentin must be closely monitored and recorded due to possible side effects. In addition, general measures must be taken to reduce the risk of stroke. People suffering from Wallenberg syndrome need to exercise enough, eat healthily and avoid stress. Depending on the size and location of the damaged area, the symptoms can subside after weeks or months.
Normally, however, the sufferers need permanent support in everyday life. It is the duty of the relatives to support the patient as much as possible. Because a stroke usually also causes mental problems, those affected should seek therapeutic support. Suitable measures are visiting a self-help group or participating in an Internet forum for affected people. By studying specialist literature, the background to Wallenberg syndrome is broken down and the disease can be better understood and accepted.
