Figure 1:
(Click on image to enlarge)
IMAGE OF THE WEEK 2013
WEEK 4
LATERAL MEDULLARY SYNDROME (WALLENBERG’S SYNDROME)
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Figure 1: (Click on image to enlarge) |
Lateral Medullary Syndrome is due to ischaemia in the distribution of the posterior inferior cerebellar artery (PICA) – a branch of the vertebral artery. It supplies the lateral aspect of the medulla oblongata, in addition to the inferior cerebellar hemisphere, vermis and tonsils.
It usually results from vertebral artery disease, such as thrombosis or dissection.
It is very challenging to make this diagnosis on CT. MRI is the imaging investigation of choice. On MRI, although apparent on the T2 sequence/FLAIR (Figure 1), it is best detected on the diffusion weighted imaging sequences (Figures 2 & 3).
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Figure 2: (Click on image to enlarge) |
Figure 3: (Click on image to enlarge) |
MRA is indicated to identify vertebral artery disease (Figure 4).
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Figure 4: (Click on image to enlarge) |
The patient presents with a series of clinical of signs with crossed face and body symptoms. These classically are:
IPSILATERAL SIGNS
1. Dysphagia and Dysarthria
2. Analgesia and Thermaesthesia on the face
3. Horner Syndrome
CONTRALTERAL SIGNS
1. Loss of pain and temperature sensation over the body
ALSO: Vertigo, Nausea, Vomiting and Nystagmus.
Images and text contributed and prepared by
Dr Ian Bickle, Department of Radiology, RIPAS Hospital.
All images are copyrighted and property of RIPAS Hospital.
