The acute vestibular syndrome with dysarthria, dysphagia, dysphonia, hemi-ataxia, and saccadic dysmetria due to the lateral medullary (Wallenberg) syndrome

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Identifier Left_Wallenberg
Title The acute vestibular syndrome with dysarthria, dysphagia, dysphonia, hemi-ataxia, and saccadic dysmetria due to the lateral medullary (Wallenberg) syndrome
Subject Acute Vestibular Syndrome, Ninth Nerve, OMS Medulla, Abnormal Saccades, Tenth Nerve, Lateropulsion, Horner Syndrome
Creator Daniel R. Gold, DO, Departments of Neurology, Ophthalmology, Neurosurgery, Otolaryngology - Head & Neck Surgery, Emergency Medicine, and Medicine, The Johns Hopkins School of Medicine; Stephen Reich, MD, Professor of Neurology, The Frederick Henry Prince Distinguished Professor in Neurology, Department of Neurology University of Maryland School of Medicine
Description This is a 50-year-old woman with the acute onset of vertigo, dysarthria, dysphagia and dysphonia/hoarseness (nucleus ambiguus), ptosis and imbalance. Her examination localized to a left lateral medullary (Wallenberg) syndrome - there was decreased sensation on the left side of the face (spinal trigeminal nucleus and tract) and the right arm and leg (spinothalamic tract), a left Horner's syndrome (oculosympathetic tract), left hemi-ataxia (inferior cerebellar peduncle), leftward ocular lateropulsion (apparent throughout the video during blinks - during eyelid closure, there is conjugate deviation to the left, and when the eyelids open, the eyes move to the right into primary gaze) which is usually seen with hypermetric saccades to the left (ipsilateral) and hypometric saccades to the right (contralateral), relating to injury of the climbing fibers traveling through the inferior cerebellar peduncle on the left side. Other ocular motor features commonly seen in a lateral medullary syndrome (not demonstrated in the video) include an ipsiversive ocular tilt reaction (1. skew deviation with a (left) hypotropia ipsilateral to the stroke, 2. ipsilesional (towards the left ear) ocular counterroll, 3. leftward head tilt) due to utricle-ocular motor pathway dysfunction; spontaneous nystagmus which is usually horizontal-torsional or pure torsional due to central semicircular canal pathway dysfunction; gaze-evoked nystagmus due to medial vestibular nucleus dysfunction. [[Number of Videos and legend for each: 1, patient with the acute vestibular syndrome due to left lateral medullary stroke.]]
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2017-12
Format video/mp4
Rights Management Copyright 2017. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright
Collection Neuro-ophthalmology Virtual Education Library: NOVEL http://NOVEL.utah.edu
Language eng
ARK ark:/87278/s6963fhm
Setname ehsl_novel_gold
Date Created 2017-12-11
Date Modified 2019-11-22
ID 1287036
Reference URL https://collections.lib.utah.edu/ark:/87278/s6963fhm