Behind the Dizziness: A Clinical Journey to Wallenberg Syndrome

TL;DR

A 41-year-old woman with atypical symptoms was misdiagnosed with a UTI before being correctly diagnosed with Wallenberg syndrome, highlighting the importance of accurate diagnosis for timely stroke treatment.

Contribution

This case highlights the diagnostic challenges of Wallenberg syndrome due to atypical presentations and the potential consequences of delayed treatment.

Findings

The patient's initial symptoms led to a misdiagnosis of a urinary tract infection.

MRI confirmed an acute left lateral medullary infarct, establishing Wallenberg syndrome.

Atypical presentations can delay stroke treatment decisions, risking long-term patient outcomes.

Abstract

Wallenberg syndrome, also referred to as lateral medullary syndrome or posterior inferior cerebellar artery (PICA) syndrome, is a rare neurological disorder most often caused by occlusion of the PICA. It leads to infarction of the lateral medulla oblongata and presents with a range of symptoms, including vertigo, ataxia, cranial nerve deficits, and sensory disturbances. We present the case of a 41-year-old female who initially attended the emergency department (ED) with headache, nausea, and vomiting. She was treated for a urinary tract infection (UTI) with associated urinary retention. However, shortly after being discharged, she collapsed within the hospital grounds. Her medical history included hypertension and type 2 diabetes mellitus (T2DM). A computed tomography (CT) head scan showed no acute findings, but a subsequent magnetic resonance imaging (MRI) confirmed an acute left lateral medullary infarct, establishing the diagnosis of Wallenberg syndrome. This atypical presentation, which caused the misdiagnosis, can have a serious effect on the treatment of a stroke and the important decision to thrombolyse or not. This delay in treatment could cause long-term damage to the patient by affecting their day-to-day life.

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