Right lateral mediullary syndrome (Wallenberg syndrome) with lateropulsion and ocular tilt reaction

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Identifier EEC-Wallenberg_syndrome
Title Right lateral mediullary syndrome (Wallenberg syndrome) with lateropulsion and ocular tilt reaction
Subject lateral medullary syndrome, Wallenberg syndrome, Horner's syndrome, skew deviation, lateropulsion, nystagmus, ocular tilt reaction
Creator Jonathan A. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine; Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of Medicine
Description A 55-year old man presented with acute onset right-sided facial numbness, left-sided body numbness, vertigo, right ptosis, and binocular vertical diplopia. External examination showed right ptosis and miosis indicating a right Horner syndrome (Figure 1). He had gaze-evoked nystagmus only on right gaze, hypermetric saccades to the right, hypometric saccades to the left, and a left hypertropia that improved with right head tilt and worsened with left head tilt. The patient's eyes were deviated to the right during eyelid closure, demonstrating ocular lateropulsion (Video 1). Dilated fundus examination revealed excyclotorsion of the right eye and incyclotorsion of the left eye (Figure 3). Axial MRI of the brain showed a hyperintensity on DWI in the right lateral medulla and a corresponding hypointensity on the ADC map consistent with an acute infarction of the right lateral medulla (Figure 4). The structures affected by the infarction in the lateral medulla include the vestibular nuclei, inferior cerebellar peduncle, descending sympathetic pathways, and lateral spinothalamic tract (Figure 5). There are prominent neuro-ophthalmic findings in a patient with Wallenberg syndrome and is usually caused by compromise of the posterior inferior cerebellar artery (PICA) leading to infarction. [[Figure 1. External examination showing right ptosis and miosis indicating a right Horner syndrome. ; ; Figure 2. Axial T1 MRI of the brain post-contrast shows the patient's eyes deviated to the right, demonstrating ocular lateropulsion, which is a compelling sensation of being pulled towards one side (the side of the lesion in Wallenberg syndrome); ; Figure 3. Fundus photos demonstrated incyclotorsion of the right eye and excylotorsion of the left eye. ; ; Figure 4. Axial MRI of the brain showed a hyperintensity on DWI in the right lateral medulla and a corresponding hypointensity on the ADC map consistent with an acute infarction of the right lateral medulla.; ; Figure 5. The structures affected by the infarction in the right lateral medulla include the vestibular nuclei, inferior cerebellar peduncle, descending sympathetic pathways, and lateral spinothalamic tract; ; Figure 6. Lateral medullary syndrome is usually caused by compromise of the posterior inferior cerebellar artery (PICA) leading to infarction.]]
Publisher Spencer S. Eccles Health Sciences Library, University of Utah
Date 2018-01
Format video/mp4
Rights Management Copyright 2018. 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/s61v9c63
Setname ehsl_novel_eec
Date Created 2018-01-09
Date Modified 2018-02-26
ID 1291695
Reference URL https://collections.lib.utah.edu/ark:/87278/s61v9c63
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