Return to: Unilateral Laryngeal Paralysis or Vocal Cord Paralysis

See also: Tapia Syndrome paralysis of vagus and hypoglossal nerves after intubation

Definitions

• Wallenberg syndrome = Lateral medullary syndrome (aka Posterior Inferior Cerebellar Artery (PICA) syndrome)
  • Constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain
    • Sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction
      • loss of pain and temperature sensation on the contralateral (opposite) side of the body
    • Sensory deficits affecting the face and cranial nerves on the same side with the infarct.
      • loss of pain and temperature sensation on the ipsilateral (same) side of the face.
• Clinical symptoms include difficulty swallowing, slurred speech, facial pain, vertigo, Horner syndrome, and possibly palatal myoclonus
  • ​Otolaryngological features include dysphonia, dysphagia and nasal regurgitation related to:
    • ​Ipsilateral vocal fold paralysis
    • Palatal and pharyngeal paresis
    • May also be associated with obstructive sleep apnea and airway obstruction (Vaidyanathan 2007)
• A complete Wallenberg syndrome is not common with key factors in clinical diagnosis being 'crossed hemiparesis or hemianesthesia' indicating a brainstem lesion
• Estimated 60,000 new cases in the United States each year with usually a better outcome - with most common sequelae being gait instability and most patients returning to satisfactory activities of daily living (Lui 2019).

Etiology

• Most commonly caused by atherothrombotic occlusion of the vertebral artery (then posterior inferior cerebellar artery and least often the medullary arteries.
• Risk factors
  • Hypertension is most common risk factor with other causes
  • Vertebral artery dissection associated with:
    • History of trauma, neck
    • Underlying collagen vascular disease

Affected Anatomy

1. Involvement of nucleus ambiguus: dysphagia, dysphonia and dysarthria
2. Laryngeal, pharyngeal and palatal paralysis
3. Involvement of trigeminal nucleus: ipsilateral facial and corneal anesthesia
4. Involvement of spinothalamic tract: loss of pain and temperature sensation to the opposite side of body
5. Involvement of cerebellum: ataxia
6. Involvement of hypothalamic fibers: sympathetic nervous system abnormal c/w Horners syndrome
7. Involvement of Deiters' nucleus and other vestibular nuclei: nystagmus and vertigo
8. Involvement of central tegmental tract: palatal myoclonus
9. Radiology (MRI)

Trigeminal Trophic Syndrome

May be associated with Wallenberg's syndrome and is a rare cause of facial ulcerations associated with injury to the trigeminal nerve (Parimalam 2014) with the syndrome comprised of triad of:

• Anesthesia
• Paresthesia
• Secondary persistent or recurrent facial ulceration

First described by Wallenberg in 1901 (cutaneous ulceration in the trigeminal dermatome)

References

Parimalam Kumar, Jayakar Thomas Trigeminal Trophic Syndrome Indian J Dermatol. 2014 Jan-Feb; 59(1): 75–76. doi: 10.4103/0019-5154.123506

Rashid RM, Khachemoune A. Trigeminal trophic syndrome. J Eur Acad Dermatol Venereol. 2007 Jul;21(6):725-31. doi: 10.1111/j.1468-3083.2007.02250.x. PMID: 17567297.

Loveman AB. An unusual dermatosis following section of the fifth cranial nerve. Arch Dermatol Syph. 1933;28:369–75

Vaidyanathan S1, Capper R, Chadha D. Stridor: an unusual presentation of lateral medullary syndrome.J Laryngol Otol. 2007 Jul;121(7):e9. Epub 2007 Mar 19.