# Wallenberg Syndrome After Leg Day Training: A Case Report

## TL;DR

A 40-year-old man developed Wallenberg syndrome after leg day training due to vertebral artery dissection, highlighting the risk of stroke from physical exertion.

## Contribution

This case report emphasizes the link between isotonic lower-limb exercise and vertebral artery dissection in young adults.

## Key findings

- The patient exhibited neurological deficits consistent with right lateral medullary syndrome after leg training.
- Imaging confirmed vertebral artery dissection and acute infarction in the right lateral medulla.
- Early diagnosis and antithrombotic therapy improved clinical outcomes and reduced long-term disability.

## Abstract

Cervical artery dissection (CAD) is an important cause of ischemic stroke in young adults, often triggered by mild cervical trauma such as abrupt neck movements during physical exertion. Vertebral artery dissection can lead to posterior circulation strokes, including lateral medullary (Wallenberg) syndrome, presenting with characteristic neurological deficits.

We report the case of a 40-year-old male who developed right-sided occipital headache, vomiting, dysphagia, dysphonia, dizziness, and sensory disturbances shortly after isotonic lower-limb exercise. Clinical examination revealed signs consistent with right lateral medullary syndrome. Laboratory analysis revealed markedly elevated creatine phosphokinase, consistent with exertional rhabdomyolysis. Imaging studies demonstrated dissection and occlusion of the distal cervical right vertebral artery and acute infarction in the right lateral medulla. Genetic testing for connective tissue disorders was negative. The patient was managed with dual antiplatelet therapy, statins, and supportive care, including rehabilitation for bulbar symptoms. At discharge, he was clinically stable with partial improvement and referred for intensive neurorehabilitation.

This case highlights the importance of considering CAD in young patients with posterior circulation stroke symptoms after physical exertion. Early diagnosis using advanced imaging and prompt antithrombotic therapy is critical. Multidisciplinary management, including rehabilitation, is essential for optimizing recovery. Awareness of this entity may improve patient outcomes and reduce long-term disability.