Lateral medullary syndrome is a neurological disorder caused by a blood clot in the vertebral artery, resulting in necrosis in the lateral part of the medulla oblongata. Symptoms include difficulty swallowing, nausea, dizziness, and facial pain. Treatment focuses on relieving symptoms, and the prognosis varies.
Lateral medullary syndrome is a neurological disorder named for the area of the lesion from which it originates: the lateral part of the medulla oblongata, which is the lower half of the brainstem. It is sometimes called posterior inferior cerebellar artery syndrome because the condition involves a blood vessel instrumental in supplying blood to the brain. Other terms include Viesseaux-Wallenberg syndrome and Wallenberg-Foix syndrome. These terms are named after the three men who contributed to the initial research and description of the disease, German internist and neurologist Adolf Wallenberg, Swiss physician Gaspard Vieusseux, and French internist and neurologist Charles Foix.
A thrombosis, or blood clotting, in the vertebral artery — which runs through the neck around the medulla oblongata — causes lateral medullary syndrome. The largest branch of the vertebral artery, the posterior inferior cerebellar artery (PICA), is particularly affected. The PICA is a major supplier of oxygenated blood to the cerebellum, the brain region responsible for motor control.
Other affected blood vessels include the superior medullary and inferior medullary arteries. With lack of blood supply, necrosis, which is the death of tissue due to disease, occurs in the lateral part of the medulla oblongata. The result is loss of temperature and sensation of pain on the side of the body and the face opposite to where the infarction is located, or the localized area of dead tissue.
The best-known symptom of this syndrome is dysphagia, or difficulty swallowing. This occurs due to paralysis of the muscles of the palate, or palate, and larynx, or larynx. Other common symptoms include nausea, dizziness, vomiting and facial pain. Some people may have coordination problems such as ataxia or loss of muscle coordination and nystagmus, which are involuntary eye movements.
Doctors focus on treating lateral medullary syndrome by relieving the symptoms associated with it so that patients can return to their daily activities to the best of their ability. For example, patients with swallowing difficulties usually require a feeding tube to be inserted through the mouth or rely on a gastrostomy, which is an operation on the stomach. Drugs such as gabapentin are used to combat pain. Doctors typically recommend blood thinners such as warfarin, as such drugs prevent blood from clotting.
The prognosis for lateral medullary syndrome varies from patient to patient. Some people may experience a symptomatic decrease over a few months or even weeks. Others, however, aren’t so lucky, as the neurological problems they contracted from lateral medullary syndrome can stay with them for the rest of their lives.
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