Clinical analysis of Wallenberg's syndrome

Abstract

Objective To summarize the clinical features of Wallenberg syndrome (WS). Methods Clinical manifestations, imaging features, etiology and predisposing factors, treatment and prognosis of 36 WS patients from March 2015 to October 2017 were retrospectively analyzed. Results Clinical manifestations of 36 patients included dizziness and vomiting in 23 cases (63.89%), bucking when drinking water and dysphagia in 21 cases (58.33%), dysarthria in 19 cases (52.78%), sensory disturbance in 17 patients (47.22%), nystagmus in 15 cases (41.67%), ataxia in 11 cases (30.56%), positive Horner signs in 8 cases (22.22%), hiccups in 7 cases (19.44%), facial nerve paralysis in 6 cases (16.67%), hemiplegia in 5 cases (13.89% ), conscious disturbance in 5 patients (13.89% ), and double vision in 2 cases (5.56% ). Twelve patients (33.33% ) had typical dorsolateral medullary syndrome. MRI revealed medulla oblongata dorsolateral infarcts, which were located in upper medulla oblongata in 10 cases (27.78%), medial medulla oblongata in 9 cases (25%) and lower medulla oblongata in 17 cases (47.22%). CTA of 10 cases showed vertebral artery (VA) stenosis in 5 patients (5/10), and posterior inferior cerebellar artery (PICA) stenosis in 3 cases (3/10). VA ultrasound of 15 cases showed narrowing or stenosis in 11 cases (11/15). Transcranial Doppler ultrasonography (TCD) of 9 cases showed slowed blood flow velocity of VA and basilar artery (BA) and peak backwards in 5 cases (5/9). Digital subtraction angiography (DSA) of 13 cases showed VA stenosis in 9 cases (9/13) and PICA stenosis in 2 cases (2/13). Six cases (16.67% ) were treated by intravenous thrombolysis, and 30 cases (83.33%) were treated by comprehensive medical treatment. Of all patients, 34 cases (94.44%) were significantly improved, including 18 cases with reduced symptoms, 6 cases with residual sensory disturbance, 6 cases with residual positive Horner sign, 4 cases with residual ataxia. Two cases (5.56% ) died of circulatory failure. Conclusions The clinical manifestations of Wallenberg syndrome are varied, only some patients have typical manifestations, therefore, the definite diagnosis needs to be combined by imaging examination. The clinical prognosis is related to the location, area of infarcts and complications.

DOI: 10.3969/j.issn.1672-6731.2019.01.010