Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature
Wallenberg syndrome is also called lateral medullary syndrome, a neurological disorder resulting from occlusion of the vertebral artery or the posterior inferior cerebellar artery. The clinical presentations are associated with a variety of indications, including vestibulocerebellar symptoms, autono...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043322005416 |
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| author | Euldes Mendes Junior Fernando Magri Ana Beatriz Ramalho Leite Silva Guilherme Pinheiro Diógenes Marina Feitosa de Castro Aguiar Lucas Bessa Luciano Barroso de Albuquerque Filho Sara Diógenes Peixoto de Medeiros Luiz Aldir da Silva Tiago Antoniol Leandro Freitas Oliveira Júlio César Claudino dos Santos |
| author_facet | Euldes Mendes Junior Fernando Magri Ana Beatriz Ramalho Leite Silva Guilherme Pinheiro Diógenes Marina Feitosa de Castro Aguiar Lucas Bessa Luciano Barroso de Albuquerque Filho Sara Diógenes Peixoto de Medeiros Luiz Aldir da Silva Tiago Antoniol Leandro Freitas Oliveira Júlio César Claudino dos Santos |
| author_sort | Euldes Mendes Junior |
| collection | DOAJ |
| description | Wallenberg syndrome is also called lateral medullary syndrome, a neurological disorder resulting from occlusion of the vertebral artery or the posterior inferior cerebellar artery. The clinical presentations are associated with a variety of indications, including vestibulocerebellar symptoms, autonomic dysfunction and ipsilateral cerebellar signs. The ipsipulsion, an abnormality of the ocular movement associated with the Wallenberg syndrome, is more specific to the lateral medullary syndrome and is characterized by a tonic deviation of the eyes in the direction of the damaged side, more prominently when the visual fixation is interrupted. A 51-year-old male patient presented with a sudden permanent rotatory dizziness, unsteady gait, numbness in the left hemibody, left palate paresis, incoordination on left side and horizontal jerk nystagmus with left fast fase. Magnetic resonance imaging showed infarction in the left medulla and cerebellar. The ocular exam revealed saccadic lateropulsion ipsilateral to lesion. In the neurologic evaluation of the patient with Wallenberg syndrome, numerous abnormalities manifestations are present, such as vestibulo-ocular reflex deficiency, saccadic abnormalities, low pursuance movements and gaze fixation, and eye alignment dysfunction. This semiologic feature had not been described in literature until now. We hypothesize that an initial vasogenic edema extending to the left medial medulla following the acute stroke could explain the early presentation with saccadic counterpulsion. After one week and regression of the edema, the finding of lateropulsion has alternated to the classic ipsipulsion related to Wallenberg syndrome. The following case report depicts a rare case of Wallenberg syndrome associated with alterations of the ocular motricity. |
| first_indexed | 2024-04-12T04:26:45Z |
| format | Article |
| id | doaj.art-6a000af4289140099f11de06a20d39f7 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-12T04:26:45Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-6a000af4289140099f11de06a20d39f72022-12-22T03:48:04ZengElsevierRadiology Case Reports1930-04332022-11-01171141484151Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literatureEuldes Mendes Junior0Fernando Magri1Ana Beatriz Ramalho Leite Silva2Guilherme Pinheiro Diógenes3Marina Feitosa de Castro Aguiar4Lucas Bessa5Luciano Barroso de Albuquerque Filho6Sara Diógenes Peixoto de Medeiros7Luiz Aldir da Silva8Tiago Antoniol9Leandro Freitas Oliveira10Júlio César Claudino dos Santos11Universidade Federal de Minas Gerais, Belo Horizonte, MG, BrazilUniversidade de São Paulo, São Paulo, SP, BrazilFaculdade de Medicina, Centro Universitário Christus, Fortaleza, CE, BrazilFaculdade de Medicina, Centro Universitário Christus, Fortaleza, CE, BrazilFaculdade de Medicina, Centro Universitário Christus, Fortaleza, CE, BrazilMedical Student, FIPMoc University Center, Montes Claros, BrazilFaculdade de Medicina, Centro Universitário Christus, Fortaleza, CE, BrazilCentro Universitário Facisa - UNIFACISA, Campina Grande, PB, BrazilNeuroftalmologia, Chistian Business School, Orlando, Estados UnidosCentro Universitário Governador Ozanam Coelho, Ubá, MG, BrazilUniversidade Federal de São Paulo, São Paulo, SP, Brazil; Laboratório de Neurociências, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Neuroftalmologia, Chistian Business School, Orlando, Estados UnidosUniversidade Federal de São Paulo, São Paulo, SP, Brazil; Laboratório de Neurociências, Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, São Paulo, SP, Brazil; Neuroftalmologia, Chistian Business School, Orlando, Estados Unidos; Corresponding author.Wallenberg syndrome is also called lateral medullary syndrome, a neurological disorder resulting from occlusion of the vertebral artery or the posterior inferior cerebellar artery. The clinical presentations are associated with a variety of indications, including vestibulocerebellar symptoms, autonomic dysfunction and ipsilateral cerebellar signs. The ipsipulsion, an abnormality of the ocular movement associated with the Wallenberg syndrome, is more specific to the lateral medullary syndrome and is characterized by a tonic deviation of the eyes in the direction of the damaged side, more prominently when the visual fixation is interrupted. A 51-year-old male patient presented with a sudden permanent rotatory dizziness, unsteady gait, numbness in the left hemibody, left palate paresis, incoordination on left side and horizontal jerk nystagmus with left fast fase. Magnetic resonance imaging showed infarction in the left medulla and cerebellar. The ocular exam revealed saccadic lateropulsion ipsilateral to lesion. In the neurologic evaluation of the patient with Wallenberg syndrome, numerous abnormalities manifestations are present, such as vestibulo-ocular reflex deficiency, saccadic abnormalities, low pursuance movements and gaze fixation, and eye alignment dysfunction. This semiologic feature had not been described in literature until now. We hypothesize that an initial vasogenic edema extending to the left medial medulla following the acute stroke could explain the early presentation with saccadic counterpulsion. After one week and regression of the edema, the finding of lateropulsion has alternated to the classic ipsipulsion related to Wallenberg syndrome. The following case report depicts a rare case of Wallenberg syndrome associated with alterations of the ocular motricity.http://www.sciencedirect.com/science/article/pii/S1930043322005416Wallenberg syndromeStrokeNeuro-ophthalmology |
| spellingShingle | Euldes Mendes Junior Fernando Magri Ana Beatriz Ramalho Leite Silva Guilherme Pinheiro Diógenes Marina Feitosa de Castro Aguiar Lucas Bessa Luciano Barroso de Albuquerque Filho Sara Diógenes Peixoto de Medeiros Luiz Aldir da Silva Tiago Antoniol Leandro Freitas Oliveira Júlio César Claudino dos Santos Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature Radiology Case Reports Wallenberg syndrome Stroke Neuro-ophthalmology |
| title | Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature |
| title_full | Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature |
| title_fullStr | Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature |
| title_full_unstemmed | Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature |
| title_short | Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature |
| title_sort | ocular contrapulsion followed by ipsipulsion in wallenberg syndrome the first case report in literature |
| topic | Wallenberg syndrome Stroke Neuro-ophthalmology |
| url | http://www.sciencedirect.com/science/article/pii/S1930043322005416 |
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