Wallenberg syndrome involves occlusion of the vertebral artery or the inferior posterior cerebellar artery. The condition is also known synonymously as Wallenberg-Foix syndrome or Viesseaux-Wallenberg. As a result, infarction occurs in a specific area of the brainstem called the dorsolateral medulla oblongata. Basically, it is a rare type of stroke.
What is Wallenberg syndrome?
In principle, Wallenberg syndrome represents a brainstem syndrome, and it is specifically a so-called alternans syndrome. In the context of Wallenberg syndrome, a wide variety of symptoms occur, depending on the neurological areas affected in each case. Wallenberg syndrome was first mentioned in 1808 by Gaspard Vieusseux. However, it received its name in reference to the physician Adolf Wallenberg. He described Wallenberg syndrome for the first time in 1895. In 1901, the first finding of the disease was made by autopsy.
Causes
The primary cause of Wallenberg syndrome is ischemia affecting the stromal area of the vertebral artery. As a result, the posterior inferior cerebellar artery becomes occluded. In addition, the dorsolateral medulla oblongata and certain areas of the cerebellum become infarcted. This damages specific pathways in the spinal cord. Certain nuclear areas, for example, those of the statoacustic nerve and vagus nerve, are also affected. In addition to occlusion of the arteries, there may be severe constriction of the blood vessels. Branches of the respective arteries may also be affected. Some of these branches are responsible for supplying the medulla oblongata. The consequence is an infarction of the lateral medulla oblongata. This results in characteristic failure symptoms. Basically, in the majority of cases, the vertebral artery is affected by Wallenberg syndrome.
Symptoms, complaints, and signs
Wallenberg syndrome includes numerous characteristic symptoms. There are often ipsilateral signs, for example, a decreased corneal reflex, disturbances in facial sensitivity, or paralysis of the vocal cords. In addition, Horner’s syndrome, hemiataxia, and paresis of the soft palate are possible. In addition, dissociated disorders related to the perception of pain and temperature occur in some cases. However, these symptoms appear exclusively on the body and not facial areas. Some patients suffer from a tendency to fall toward the affected side and complain of ipsilateral nystagmus. If the nucleus spinalis nervi trigemini is affected, pain sensation is lost on the ipsilateral side of the face. The corneal reflex is severely diminished or completely absent. When the tractus spinothalamicus is damaged, the perception of temperature or pain is absent on that half of the body facing the infarct. Lesions of the cerebellum or inferior cerebellar peduncles usually result in ataxia. When hypothalamospinal fibers are damaged, sympathetic transmission of signals is impaired. As a result, the so-called Horner syndrome may occur. If the nucleus Deiter is affected, dizzy spells and eye tremors occur. Other possible symptoms of Wallenberg syndrome include hoarseness, hemiataxia, dysarthria, and hypacusis. In addition, trigeminal disorders are possible.
Diagnosis and course of the disease
To establish the diagnosis of Wallenberg syndrome, the first part of the examination involves taking a medical history. In this process, the attending physician discusses the patient’s medical history together with the patient with the disease. In the course of this, genetic strains, certain previous illnesses, chronic diseases and the person’s personal lifestyle are analyzed. The medical history provides the physician with initial indications for the diagnosis. Subsequently, various clinical examinations are performed. In particular, the typical symptoms of Wallenberg syndrome are clarified. If the patient suffers from several characteristic symptoms, the suspicion of Wallenberg syndrome is confirmed. The prognosis of Wallenberg syndrome depends on the location and size of the area damaged by the stroke. By means of recanalization, the symptoms of Wallenberg’s syndrome recede in some patients after a few weeks to months.However, in the majority of affected individuals, neurologic complaints and functional disorders continue to appear even after several years.
Complications
Wallenberg syndrome is a serious complaint that can lead to severe complications and limitations in the daily life of the affected person. Patients suffer from an infarction in the brain in this case, so that there are sensory disturbances or paralysis in the face of the affected person. This can also lead to swallowing difficulties, so that patients can no longer take food and liquids without difficulty and are therefore dependent on the help of other people in their daily lives. A false sensitivity to temperatures and pain may also develop with Wallenberg syndrome, so that affected individuals may not be able to recognize dangers properly. Similarly, speech can be negatively affected by the syndrome, which can lead to severe difficulties, especially in children. Patients often suffer from eye tremor or permanent hoarseness. The quality of life of the affected person is significantly limited and reduced by Wallenberg syndrome. The treatment of Wallenberg syndrome is always based on the symptoms, since no causal treatment is possible. No particular complications occur, although a complete cure cannot be achieved. Frequently, the syndrome has a very negative effect on the quality of life of the affected person and can promote psychological complaints or even depression.
When should one go to the doctor?
Since Wallenberg syndrome cannot heal on its own, the person affected by this disease is definitely dependent on a visit to a doctor. Only early detection and treatment of this syndrome can prevent further complications and discomfort. Early detection always has a very positive effect on the further course of the disease. First and foremost, attacks of dizziness indicate the disease. Those affected can no longer concentrate properly and also suffer from significant confusion. Likewise, there may be trembling at the eyes or severe hoarseness, which may indicate Wallenberg syndrome. There is a marked change in the perception of temperature and pain in various parts of the body. If these symptoms occur without any particular reason and do not disappear on their own, a doctor must be consulted in any case. In emergencies, an emergency doctor 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 result in a decreased life expectancy for the affected individual.
Treatment and therapy
In principle, therapy for Wallenberg syndrome is exclusively symptomatic. If swallowing is difficult, insertion of a feeding tube is required in some cases. Logopedic treatment may also be prescribed to relieve discomfort with swallowing and speech. In some cases, medications are also used to reduce pain. Gabapentin is suitable for the treatment of chronic pain in this case. 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 appropriate measures are based primarily on individual risk factors. For example, aspirin therapy is used so that the risk of another stroke is reduced. In the case of atrial fibrillation, anticoagulants are necessary. In some cases, other drugs are used, for example preparations to treat high blood pressure. In addition, lifestyle changes are helpful in some patients.
Prevention
Statements regarding the prevention of Wallenberg syndrome are possible only to a limited extent. This is because the disease cannot be prevented in every case. However, certain personal lifestyle factors play a role in the development of the disease. Central to this is the health of the blood vessels and cardiovascular system in particular.
Aftercare
In most cases, the options for aftercare in Wallenberg syndrome are significantly limited and often not available to the affected person at all.Therefore, in the case of this disease, the affected person should see a doctor as early as possible and initiate treatment to prevent the occurrence of other complaints and complications. As a rule, self-healing cannot occur. Since Wallenberg syndrome is also a genetic disease, it can be inherited, so if a person wishes to have children, genetic testing and counseling should be done first and foremost to prevent recurrence. As a rule, those affected by this disease rely on the measures of physiotherapy and physical therapy to alleviate the symptoms. Likewise, the help and support of one’s family in everyday life is very important, as this can also prevent depression and other psychological upsets. In many cases, contact with other people affected by the disease is also very useful to find out how to cope with everyday life with the disease more easily. A general course of Wallenberg syndrome cannot be predicted.
What you can do yourself
Wallenberg syndrome requires individual therapy, which depends on the particular symptoms of the stroke. For example, speech or swallowing therapy may be needed to help regain lost skills. These therapies can be supported at home by independent practice. The use of medications 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. Individuals suffering from Wallenberg syndrome must exercise sufficiently, eat a healthy diet, and avoid stress. Depending on the size and location of the damaged area, symptoms may subside after weeks or months. Normally, however, the sufferers require permanent support in everyday life. It is the task of the relatives to support the patient as much as possible. Because a stroke usually also causes psychological problems, those affected should seek therapeutic support. Suitable measures include attending a self-help group or participating in an Internet forum for affected people. By studying specialized literature, the background of Wallenberg syndrome is broken down and the disease can be better understood and accepted.
