SDMRad

 

Radiological Findings, Disease course and Management

                                         

                           MRI Brain

 

  

 

 

 

                                                                        

 

 

               

 

 

 

 

 

  

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Findings

• Acute infarct in postero lateral right medulla seen as hyperintense signal.

• Absent flow void in the proximal intracranial portion of right vertebral artery. Suggestive of occlusion within the vessel.

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Discussion

• Lateral medullary syndrome, or Wallenberg syndrome.

• It is an acute ischemic infarct due to occlusion of the vessels supplying the lateral medulla oblongata. 

• Most common occlusion is of the intracranial portion of the vertebral artery or PICA and it's branches.

• Occlusion may be due to atherothrombosis or embolism or spontaneous dissection of vertebral arteries

 

Diagnosis

• The triad of Horner's syndrome, ipsilateral ataxia, and ipsilateral hyperalgesia clinically identify patients with the lateral medullary syndrome. 

• Other manifestations include numbness, dysphagia, vertigo, nausea-emesis, hoarseness, hiccups, facial pain, visual disturbance.

 

MRI 

• Hyperintense lesions involving the lateral medulla oblongata  on T2W and FLAIR images suggestive of infarcts.

• MR Angiography: Focal loss of flow void at the site of vessel obstruction

• MRI can demonstrate coexisting cerebellar infarction that may have previously been clinically unsuspected and undetected by CT. 

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References

• Shetty, S. R., Anusha, R. L., Thomas, P. S., & Babu, S. G. (n.d.). Wallenberg's syndrome. Retrieved October 25, 2016, from http://pubmedcentralcanada .ca/pmcc/articles/PMC3271596/

• ​Gaillard, F., & Rezaee, A. (n.d.). Lateral medullary syndrome | Radiology Reference Article | Radiopaedia.org. Retrieved October 25, 2016, from https://radiopaedia.org/articles/lateral-medullary-syndrome

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