Wallenberg Syndrome 1
Topic: Behavior
Created on Sunday, September 17 2006 by jdmiles
Last modified on Sunday, November 16 2008.
A famous elderly, retired model presents to the E.R. She had no neurologic defecits prior to this morning, when she awoke to several new symptoms, the most concerning to her of which are changes in the way her face looks, as shown in the image above.
She has smoked 2 packs of cigarettes per day for the past 56 years. She is overweight, has sleep apnea, and a recent LDL cholesterol level was 469 mg/dL. She has diabetes mellitus, and a recent hemoglobin A1C was 12. She has a history of poorly controlled hypertension. She is noncompliant with the medications prescribed to her for these conditions.
History and physical exam reveal new onset of loss of pain and temperature sensation in the right face, decreased motion of the vocal cord on the right, nausea and vomiting, vertical diplopia, anhidrosis in the right face, hoarseness, lateropulsion to the right, paresthesias on the right side of the face, vertigo, loss of pain and temperature sensation in the left side of the body, nystagmus, oscillopsia, dysphagia, and ataxia on the right.
Of the following choices, which ONE other finding would you MOST expect to see in this patient?
A) Action tremor B) Cataplexy C) Dementia D) Brain death E) Loss of gustation
This question was created on September 17, 2006 by jdmiles.
This question was last modified on November 16, 2008.
ANSWERS AND EXPLANATIONS
A) action tremor
This answer is incorrect.
Action tremor is not a component of the lateral medullary (Wallenberg) syndrome, and would not be expected from a lesion of the lateral medulla. (
See References)
|
| | |
| | |
Please log in if you want to rate questions. |
B) cataplexy
This answer is incorrect.
Cataplexy is not a component of the lateral medullary (Wallenberg) syndrome, and would not be expected from a lesion of the lateral medulla. (
See References)
|
| | |
| | |
Please log in if you want to rate questions. |
C) dementia
This answer is incorrect.
Dementia is not a component of the lateral medullary (Wallenberg) syndrome, and would not be expected from a lesion of the lateral medulla. (
See References)
|
| | |
| | |
Please log in if you want to rate questions. |
D) brain death
This answer is incorrect.
Brain death is not a component of the lateral medullary (Wallenberg) syndrome, and would not be expected from a lesion of the lateral medulla. (
See References)
|
| | |
| | |
Please log in if you want to rate questions. |
E) loss of gustation
This answer is correct.
This patient presents with history and physical findings consistent with a stroke in the lateral medulla (Wallenberg syndrome). Her findings are consistent with infarction on the right side of the medulla. A stroke in this location will cause damage to the vestibular nuclei, spinothalamic tract, descending sympathetic fibers, descending fibers of cranial nerves IX and X, and cerebellar tracts including the inferior cerebellar peduncle.
Damage to these structures produces a predictable constellation of symptoms, including nystagmus, vertigo, oscillopsia, nausea and vomiting, loss of pain and temperature in the contralateral half of the body, loss of pain and temperature sensation in the ipsilateral face, an ipsilateral Horner's syndrome (as shown in the image), hoarseness and dysphagia, ataxia, and ipsilateral lateropulsion.
You could expect to see loss of gustation in this patient. (
See References)
|
| | |
| | |
Please log in if you want to rate questions. |
References:
1. Zaidat, O.O., and Lerner, A.J. (2002). The Little Black Book of Neurology, 4th Edition. Mosby, St. Louis. (ISBN:0323014151) | Advertising:
|
2. Victor, M., and Ropper, A.H. (2001). Adams and Victor's Principles of Neurology, 7th Edition. McGraw-Hill, New York. (ISBN:0070674973) | Advertising:
|
|
| | |
| | |
Please log in if you want to rate questions. |
FrontalCortex.com -- Neurology Review Questions -- Neurology Boards -- Board Review -- Residency Inservice Training Exam -- RITE Exam Review
behavior
Wallenberg Syndrome 1
Question ID: 69171
Question written by J. Douglas Miles, (C) 2006-2009, all rights reserved.
Created: 09/17/2006
Modified: 11/16/2008
Estimated Permutations: 0