What are the Common Symptoms of Wallenberg Syndrome?

Wallenberg Syndrome Guide: Causes, Diagnosis & Rehabilitation

Wallenberg syndrome is among the most frequently seen conditions resulting from a brainstem stroke caused by reduced blood flow in the Vertebral Artery (VA) or the Posterior Inferior Cerebellar Artery (PICA). Also referred to as Lateral Medullary Syndrome or PICA Syndrome, it belongs to a group of brainstem stroke syndromes triggered by ischaemic strokes affecting the posterior circulation.

The symptoms of Wallenberg syndrome usually start suddenly. However, in approximately 25% of people, the symptoms develop slowly over several hours or days. At first, they may have headaches or migraines, along with dizziness and trouble walking. Other symptoms often appear later.

Continue reading to learn how to recognise the symptoms of Wallenberg syndrome, its causes and other crucial aspects.

What are the symptoms of Wallenberg syndrome?

Wallenberg syndrome can present with a variety of symptoms, depending on the specific location where the vertebral artery is blocked or torn and the extent of damage to the brain tissue.

Typical symptoms of Wallenberg syndrome may include:

• Vertigo or feelings of dizziness
• Trouble swallowing
• Nausea and episodes of vomiting
• Problems with balance or coordination
• Persistent hiccups that are hard to control
• Involuntary eye movements (known as nystagmus)
• Loss of the sense of taste
• Decreased sensation of pain or temperature on one side of the body

The complex structure of the brainstem and its extensive network of connections can lead to symptoms that appear on opposite sides of the body. For instance, a person might lose pain sensation on the right side while struggling with balance issues on the left side.

What Causes Wallenberg Syndrome?

The following is a detailed overview of the Wallenberg syndrome causes:

• Wallenberg syndrome most commonly occurs due to injury to a section of the brainstem known as the medulla.
• This injury typically results from a reduction in blood flow to that area. The brain depends on a vast system of arteries to deliver blood and oxygen to all its regions.
• When oxygen delivery is interrupted, brain cells begin to die rapidly, often leading to a stroke.
• Around 80% of Wallenberg syndrome cases are caused by a blockage in the vertebral artery, which provides blood to the brainstem.
• This blockage can occur due to blood clots, fatty plaque buildup, or other particles, resulting in an ischaemic stroke that damages brain tissue and triggers Wallenberg syndrome.

In some cases, Wallenberg syndrome is linked to a tear or injury in the vertebral artery itself. Among individuals younger than 45, vertebral artery tears are the leading cause of the condition. Such damage to the artery may stem from:

• Trauma to the neck
• Fibromuscular dysplasia
• Connective tissue disorders, such as Ehlers-Danlos syndrome

How to Prevent Wallenberg Syndrome?

Since Wallenberg syndrome often results from a stroke, following general stroke prevention strategies can help reduce the risk. They include:

• Managing high blood pressure through a combination of medication and lifestyle adjustments.
• Limiting the intake of cholesterol, saturated fats, and trans fats to help prevent plaque buildup in the arteries.
• Avoiding tobacco use, since smoking increases the risk of stroke for both smokers and individuals exposed to secondhand smoke.
• Controlling diabetes with a healthy diet, regular physical activity, weight management, and medications when necessary.
• Maintaining a healthy body weight to lower the chances of developing stroke-related conditions like high blood pressure, heart disease, and diabetes.
• Individuals with such symptoms must consume at least five servings of fruits and vegetables daily. A Mediterranean-style diet, rich in olive oil, fruits, nuts, vegetables, and whole grains, may also lower stroke risk.
• Engage in regular exercise to help reduce blood pressure, raise good cholesterol levels, improve blood vessel and heart health, maintain a healthy weight, control blood sugar, and alleviate stress.
• Limit alcohol intake. Excessive drinking increases the risk of high blood pressure and ischaemic strokes, while light to moderate drinking (such as one drink daily) might offer some protection against ischaemic stroke.
• Seek medical care if obstructive sleep apnoea (OSA) is suspected, as untreated OSA can increase stroke risk.
• Avoid the use of illegal substances like cocaine and methamphetamine, which are known to elevate the risk of stroke.
• If an ischaemic stroke has previously occurred, take prescribed medications as directed to prevent future strokes.

How to Treat Wallenberg Syndrome?

The treatment of Wallenberg syndrome primarily aims to eliminate the obstruction or blockage affecting the blood flow to the brainstem. When a stroke is involved, healthcare providers may promptly administer one or more of the following interventions:

• Tissue plasminogen activator (tPA), delivered through an IV in the arm
• Anticoagulant or blood thinner medications
• A surgical procedure known as thrombectomy, which is rarely feasibleused to clear the blocked artery.

Once the blockage has been addressed, the focus shifts to managing symptoms and potential complications. This can involve:

• Using a feeding tube if swallowing becomes problematic
• Prism glasses may aid diplopia in rare cases but do not address typical nystagmus or skew deviation.
• Undergoing speech therapy
• Participating in physical therapy
• Engaging in occupational therapy

Wallenberg syndrome impacts individuals in different ways due to the unpredictable nature of stroke-related damage. This can be a distressing situation for both patients and their families. Certain symptoms may slowly get better over a period of months, though some individuals may still face complications.

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