FrontalCortex, Inc. is a non-profit corporation dedicated to neurology education.

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 3 packs of cigarettes per day for the past 41 years. She is overweight, has sleep apnea, and a recent LDL cholesterol level was 676 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 side of the body, anhidrosis in the left face, vertical diplopia, paresthesias on the left side of the face, diminished gag reflex, nausea and vomiting, oscillopsia, an illusion of titling of vision, decreased elevation of the palate on the left, dysphagia, loss of gustation, ataxia on the left, lateropulsion to the left, and hoarseness.
Of the following choices, which ONE other finding would you MOST expect to see in this patient?

 
        A) Loss of olfaction
 
        B) Left homonymous hemianopsia
 
        C) Dawson’s fingers
 
        D) Nystagmus
 
        E) Decreased elevation of the palate on the right
 

 


Back to the question = Go back to the top of the page.
See another question like this one = Reload a different version of this question ().
Click here for a random question = Load a random question from the database.
Clone this question = Use this question as a template to create a totally NEW question.
Rate this question = Enter detailed rating for this question!
Average user rating for this question = 4 = How users like you have rated this question.
This question was created on September 17, 2006 by jdmiles.
This question was last modified on November 16, 2008.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANSWERS AND EXPLANATIONS




A) loss of olfaction

This answer is incorrect.


Loss of olfaction would be seen in a right lateral medullary infarct, but not in a left lateral medullary infarct, which this patient has.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




B) left homonymous hemianopsia

This answer is incorrect.


Left homonymous hemianopsia is not a component of the lateral medullary (Wallenberg) syndrome, and would not be expected from a lesion of the lateral medulla.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




C) Dawson’s fingers

This answer is incorrect.


Dawson’s fingers is not a component of the lateral medullary (Wallenberg) syndrome, and would not be expected from a lesion of the lateral medulla.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




D) nystagmus

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 left 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 nystagmus in this patient.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
Please log in if you want to rate questions.

 

 

 

 

 

 

 

 

 




E) decreased elevation of the palate on the right

This answer is incorrect.


Decreased elevation of the palate on the right would be seen in a right lateral medullary infarct, but not in a left lateral medullary infarct, which this patient has.  (See References)

Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
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:
Back to the questionSee another question like this oneClick here for a random questionClone this question Rate this questionAverage user rating for this question = 4
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

User Comments About This Question:

1 user entries
 

jdmiles
adult Another Mona Lisa question Dec 08, 2007 @ 12:35
This is the third of the Mona Lisa questions, this time with a lateral medullary syndrome.


 
Please log in if you'd like to add a comment.