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Medullary Stroke: Wallenberg's Syndrome
Wallenberg’s syndrome
- Most commonly occurs from a posterior inferior cerebellar artery territory infarct caused by a branch occlusion of a vertebral artery.
- Patients typically present with dizziness, incoordination, double vision, trouble swallowing, sensory disturbance, and pupillary asymmetry.
- This particular patient presented with symptomatic bradycardia from the injury to the cardiorespiratory center.
- Exam reveals unilateral cerebellar ataxia; loss of pain and temperature sensation in the face and body (typically on opposite sides); ipsilateral Horner’s syndrome (ptosis, anhidrosis, and miosis); dysarthria and impaired gag reflex; ocular skew; and nystagmus, and wild swings in heart rate with pronounced bradycardia (HR in the mid 30's to upper 80's).