The Analysis Of Clinical Manifestation Of The Wallenberg Syndrome

Wallenberg syndrome is a set of clinical syndromes whichis caused by the impairment of the conduction bundle and nerveganglion of the dorsal medulla due to the blocking of posteriorinferior cerebellar aneurysms (PICA). Typical clinicalmanifestation of dorsolateral medullarry syndrome is mainlywith five symptoms, namely, megrim, nausea, vomit and nystagmus.(Damage of the vestibule-cerebellar fibers); true bulbarparalysis including swallowing difficulty, hoarseness,drinking cough, uranoplegia and gag reflex reducing on the sickside, etc (Glossopharyngeum and vagus nerve are likely to beimpaired); normal tactile sense of face in the same side, lossof pain and thermal, reducing or loss of pain and thermal onthe offside body (Nucleus of spinal trigeminal tract andlateral spinothalamic tract are impaired); Homer syndrome(sympathetic nerve is impaired); cerebellar ataxia in thelesion side (part of the cerebellum and restiform body areimpaired).Objectives: Through the retrospective analysis of41cases ofdorsolateral medullary syndromes, discussion of the clinicalcharacteristics of dorsolateral medullary syndrome is carried out thus to provide references for prevention and clinicaltreatment.Methods: To analyze by reviewing the clinical data of41casesof dorsolateral medullary syndromes diagnosed in thedepartment of neurology in China-Japan Union Hospital of JilinUniversity from October,2013to December,2014and386casesof acute cerebral infarction in the same period (including thefollowing41cases). All the cases of acute cerebral infarctionconform to the diagnostic criteria of cerebral arterialthrombosis that was revised by the fourth session meeting ofcerebrovascular disease. A statistic analysis is made to thedescription of clinical characteristics which are differentrisk factors, symptoms, signs, imaging performances andprognosis, etc.Results:1. the peak age of dorsolateral medullary syndrome wasabout57to64in the group. For those who were not diagnosedas dorsolateral medullary syndrome patients, the peak age ofcerebral infarction were about65-73.2. There was a greatdifference of the gender make-up which had a statisticallysignificance (P<0.05). Among which, the number of male was32,whereas, the number of female was9.3. For the predictable riskfactors such as high blood pressure, diabetes, hyperlipidemia, hyperhomochysteinemia, smoking, drinking, etc, thedifferences was statistically significant.4. The commonclinical performances of the dorsolateral medullary syndromepatient in this group were megrim, swallowing difficulty.Additionally, the performance contained dysarthria,hemidysesthesia, nystagmus, ataxia, hiccup, Homer syndrome,central facial paralysis, and monoparesis, positivepathological reflex as well as diplopia.5. The patients ofdorsolateral medullary syndrome all had a head MRI examination,among which32cases of patients had head CT examination andthe there was responsible lesion in the brainstem by the headMRA examination;38cases of the patients were found to sufferencephalic and cervical vessel by ultrasonic testing;29casesof the patients had a head MRA examination, among which,18cases had vertebral artery stenosis in the lesion, unstableplaque and dysplasia. There were6cases of hemadostenosis anddysplasia. And nothing abnormal was detected in2cases.6. Bysystemic treatment,39cases had recovered, among which in19cases, the symptom of the patients gradually disappeared in2to3week course, in6cases the patients suffered sensorydisturbance,4cases suffered the sequelae of Homer syndrome,2case suffered the sequelae of ataxia and2cases died of respiratory failure.Conclusion:1.The peak age of dorsolateral medullary syndromeis about57to64, and the incidence rate for male is higherthan that of female;2. Smoking and drinking are the independentrisk factors for male while debates is the independent riskfactor for male.3. The major clinical performances ofdorsolateral medullary syndrome are megrim, swallowingdifficulty, dysarthria, hemidysesthesia, nystagmus, ataxia,hiccup and Homer syndrome; in addition, central facialparalysis, monoparesis, positive pathological reflex as wellas diplopia are relatively less in clinical performance.4. Theprognosis of dorsolateral medullary syndrome is perfect.