Wallenberg Syndrome: Two Case Reports Highlighting Vertebral Artery Dissection and Thrombophilia as Distinct Etiologies

TL;DR

Two case reports show different causes of Wallenberg syndrome, highlighting the need for accurate diagnosis and multidisciplinary care.

Contribution

The paper presents two distinct etiologies of Wallenberg syndrome: vertebral artery dissection and thrombophilia.

Findings

Case 1 showed vertebral artery dissection as the cause of Wallenberg syndrome.

Case 2 revealed thrombophilia-related infarction without dissection.

MRI was crucial for diagnosis, as CT scans were inconclusive.

Abstract

Wallenberg syndrome, or lateral medullary syndrome, is caused by ischemia of the posterolateral medulla, most often attributed to vertebral artery or posterior inferior cerebellar artery occlusion. The condition is characterized by heterogeneous sensory, cerebellar, and autonomic deficits induced by damage to multiple brainstem nuclei and tracts. Herein, we report two cases of Wallenberg syndrome associated with different etiological mechanisms. Case 1 involved a 55-year-old man with vertigo, diplopia, anisocoria with ipsilateral ptosis, and left-sided sensory deficits. Magnetic resonance imaging (MRI) revealed a 9-mm diffusion-restricted lesion in the right posterolateral medulla and signs of proximal intracranial vertebral artery dissection. Case 2 involved a 41-year-old man with vertigo, dysphonia, dysphagia, ipsilateral facial sensory loss, and contralateral body hypoalgesia. MRI showed an acute small infarct in the right posterolateral medulla without evidence of dissection. The computed tomography scan findings were inconclusive in both cases, thereby emphasizing the diagnostic value of diffusion-weighted MRI. The cardiac studies had unremarkable results. Both patients received antiplatelet therapy, vascular risk factor management, and early rehabilitation. These cases underscore the diversity of mechanisms underlying Wallenberg syndrome. Further, they emphasize the importance of prompt diagnosis, vascular imaging, and multidisciplinary management to improve outcomes.

Figures