Ocular contrapulsion followed by ipsipulsion in Wallenberg syndrome: The first case report in literature

Radiology Case Reports

article

Euldes Mendes Junior¹  Fernando Magri¹  Ana Beatriz Ramalho Leite Silva¹  Guilherme Pinheiro Diógenes¹  Marina Feitosa de Castro Aguiar¹  Lucas Bessa¹  Luciano Barroso de Albuquerque Filho¹  Sara Diógenes Peixoto de Medeiros¹  Luiz Aldir da Silva¹  Tiago Antoniol¹  Leandro Freitas Oliveira¹  Júlio César Claudino dos Santos¹ 

[1] Universidade Federal de Minas Gerais

关键词: Wallenberg syndrome;    Stroke;    Neuro-ophthalmology;   

DOI  :  10.1016/j.radcr.2022.06.099

学科分类：生物化学工程

来源: University of Washington * Department of Radiology

【 摘 要 】

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.

【 授权许可】

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