The wallenberg syndrome or lateral bulbar infarction is a type of ischemic cerebral vascular disease. It is a pathology that fundamentally affects the posterior blood circulation, manifesting itself with easily identifiable neurological symptoms.
Clinically, Wallenwerg syndrome is characterized by the presence of a basic symptomatic triad: Horner syndrome, ipsilateral ataxia, and sensory disturbances. Other types of medical complications may appear such as nausea, vomiting, vertigo, headache, muscle hypertonicity, etc..
The etiological origin of this pathology is found in the occlusion of the posterior, inferior cerebellar artery or the vertebral artery. Various medical conditions such as hypertension, vasculitis, hypercholesterolemia, arteriosclerosis, head trauma, among others can develop secondarily..
In addition, the diagnosis of Wallenberg syndrome usually combines clinical examination with the performance of various neuroimaging tests, such as computed tomography (CT) and magnetic resonance imaging (MRI). Treatment focuses both on emergency medical intervention and on the control of its etiological causes..
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Wallenberg syndrome is made up of a set of neurological symptoms resulting from a cerebrovascular accident.
The World Health Organization (WHO), among other international organizations, have pointed out on various occasions that vascular-brain diseases are the second leading cause of death worldwide. Specifically, more than 4 million people in developed countries die from this type of pathology.
Our nervous system, especially the brain areas, are nourished by a wide network of blood vessels that redirect the flow of blood in a homogeneous and constant way to all the structures, in order to maintain their functional activity..
The cerebral circulatory system is fundamentally based on four large arteries organized into two systems: the posterior system -vertebrovasilar- and the anterior -carotid- system. At a specific level, they irrigate different areas:
A cerebrovascular accident or disease develops when some type of abnormal or pathological event suddenly interrupts the blood flow to one or more areas of the brain.
In this sense, a wide group of events that can cause it to block have been described: ischemic accidents or cerebral hemorrhages..
In the particular case of Wallenberg syndrome, an ischemic process occurs in which blood flow is partially or totally reduced, due to a local or specific occlusion..
The specific consequences will vary depending on the part of the cerebral circulatory system in which the occlusion occurs and, therefore, the brain and nerve areas that lose blood supply.
Generally, the occlusion of the blood supply tends to be located in the inferior posterior cerebellar artery (PICA), which is mainly responsible for nourishing a good part of the medulla oblongata and lower areas of the cerebellar hemispheres. Because of this, Wallenberg syndrome receives other names, such as lateral bulbar infarction, cerebellar artery syndrome or lateral medullary syndrome..
Wallenberg syndrome is one of the most frequent pathologies within the cerebrovascular accidents that affect the posterior regions.
More than 80% of cerebrovascular attacks or episodes are due to ischemic processes and, of these, 20% specifically affect nervous tissues irrigated by the posterior circulation system..
Although specific data on its incidence are not known, it is a disease fundamentally associated with the male sex, with a ratio of 3: 1, in relation to the female sex.
Another of the sociodemographic factors related to the increase in the prevalence of Wallenberg syndrome is age. In this sense, the average age of presentation is close to 60 years..
In addition, it is a disease closely related to various risk factors, such as high blood pressure, high cholesterol levels, heart disease or diabetes..
Because of this, Wallenberg syndrome is a rare neurological disorder in children or young adults. However, it can also present as a secondary process to surgical interventions or head trauma..
The signs and symptoms produced by Wallenberg syndrome are usually easily recognizable at the clinical level, since in most cases they are characterized by a systematic pattern consisting of:
The first clinically evident manifestations of Wallenberg syndrome are nausea and vomiting.
Patients often describe the sudden presence of painful or bothersome gastric sensations, accompanied by an uncontrollable urge to vomit..
Generally, the picture of discomfort tends to evolve towards the presence of recurrent vomiting, that is, to the expulsion of the contents of the stomach.
Another of the initial signs is constituted by the sudden appearance of vertigo in the absence of other types of triggering factors or events. Vertigo is usually described clinically as suffering from feelings of dizziness, instability, movement and / or spinning.
Patients who present vertigo, as part of the clinical course of Wallenberg syndrome, report that they are constantly moving or turning..
In most cases, vertigo can be accompanied by nausea, loss of balance, falls, or temporary loss of consciousness..
In addition to the events described above, patients affected by Wallenberg syndrome often present with ataxic processes. These usually affect mainly the upper and lower extremities on one side of the body structure..
Ataxia is defined as a symptom of neurological origin that causes a wide variety of alterations in motor coordination and the control of various muscle groups.
Normally, patients describe the presence of involuntary movements, lack of control, difficulty in executing voluntary motor acts, among other alterations.
Poor or absent blood flow in different nerve areas, especially in brainstem and spinal cord areas, can cause impaired respiratory function.
The most common is that some symptoms related to:
The presence of sensory symptoms will depend fundamentally on the brain and spinal areas that are affected.
However, in most cases, these are characterized by including:
The clinical characteristics of Horner syndrome constitute another of the central points within the clinical course of Wallenberg syndrome. Horner syndrome is a neurological disorder that affects the integrity of the nerve networks that are distributed from the hypothalamus to the facial and ocular areas..
In addition to Wallenberg syndrome and cerebrovascular accidents, Horner syndrome can appear as a consequence of recurrent headaches and migraine processes, tumor formations, injections and surgical procedures or mechanical injuries among others..
Some of the most significant medical consequences of Horner syndrome include:
Although they are less frequent, affected patients may present various alterations within the cognitive sphere:
These characteristics, together with the possible physical alterations, usually cause a state of significant dependency.
Normally, people with Wallenberg syndrome require the help of someone to carry out a good part of routine activities such as: eating, showering, walking, etc..
The clinical features of Wallenberg syndrome are the result of a cerebrovascular accident.
Although heart attacks and strokes can appear due to a wide variety of factors, in the case of Wallenberg syndrome, it is especially associated with:
At a clinical level, it is easy to identify this pathology due to the magnitude of its manifestations and the restricted nature of the symptomatic variety.
In emergency medical services, the preliminary physical examination allows early identification of the presence of a cerebrovascular pathology.
Subsequently, various laboratory tests are used to locate the site of the arterial occlusion. Some of the most used are computerized tomography or nuclear magnetic resonance.
The medical interventions used in Wallenberg syndrome are mainly symptomatic. They focus on the treatment of medical complications and possible secondary functional repercussions..
In general, an approach similar to that designed for the treatment of stroke is usually used..
After stabilization in Wallenberg syndrome, the physical and neuropsciological rehabilitation of the patient is essential.
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