Wallenberg Syndrome

What is Wallenberg syndrome?

Wallenberg syndrome is a neurological disorder that happens after an event that affects how blood flows to your brainstem, like a stroke or blood clot. It leads to symptoms like difficulty swallowing, dizziness and involuntary eye movements. It may make you feel as if everything you see is tilted. This can affect your balance and coordination.

You may hear your healthcare provider refer to Wallenberg syndrome as lateral medullary syndrome or posterior inferior cerebellar artery syndrome, as these are areas where damage can occur.

Treating the cause of Wallenberg syndrome quickly leads to the best outcome and reduces your risk of complications.

How common is Wallenberg syndrome?

Wallenberg syndrome is the most common condition that happens after a posterior ischemic stroke. One study estimates that there are more than 60,000 new cases of Wallenberg syndrome diagnosed each year in the United States.

What are the symptoms of Wallenberg syndrome?

Some of the most common symptoms of Wallenberg syndrome include:

• Difficulty swallowing
• Hoarse voice
• Hiccups
• Loss of sense of taste
• Fast, involuntary eye movements (nystagmus)
• Double vision
• Issues with balance and coordination
• Dizziness and vertigo
• Pain or numbness

Symptoms may affect only one side of your body. For example, you could lose the feeling of pain or temperature on one side of your face but not the other.

Your symptoms may get worse (progress) over a couple of hours to days. Symptoms vary based on where damage within your brain or brainstem occurred.

What causes Wallenberg syndrome?

A brainstem stroke causes Wallenberg syndrome. This can happen after:

• Damage to the lateral part (side) of your medulla oblongata
• Blood flow blockages through the posterior inferior cerebellar artery (PICA) to your cerebellum or the vertebral artery in your brainstem

Other less common causes of Wallenberg syndrome include:

• Vertebral artery dissection
• Arteriovenous malformations
• Head injury
• Multiple sclerosis

What are the risk factors for Wallenberg syndrome?

You’re more at risk of Wallenberg syndrome if you:

• Smoke or use tobacco products
• Have hypertension
• Have diabetes

Less common conditions that may be a risk factor for Wallenberg syndrome include connective tissue conditions like:

• Marfan syndrome
• Ehlers–Danlos syndrome
• Fibromuscular dysplasia

What are the complications of Wallenberg syndrome?

You may experience permanent changes after a post-stroke condition like Wallenberg syndrome, including:

• Difficulty walking
• Chronic pain
• Epilepsy
• Learning disabilities

How is Wallenberg syndrome diagnosed?

A healthcare provider will diagnose Wallenberg syndrome after a physical exam, neurological exam and testing.

Your provider will look for symptoms that affect only one side of your body to pinpoint where there might be damage. For example, you may lose your sense of taste on the right side of your tongue. This tells your provider that you may have damage to the left side of your brainstem. Your brain works like a mirror, so the right side of your brain regulates the left side of your body and vice versa.

To confirm a diagnosis, your provider will offer testing, which may include:

• An MRI
• An angiogram

Your provider may order other tests, like blood tests or an electrocardiogram, to rule out other conditions with similar symptoms.

How is Wallenberg syndrome treated?

Treatment for Wallenberg syndrome first focuses on removing the obstruction or blockage of blood supply to your brainstem. In the case of a stroke, your provider will quickly offer one or a combination of the following:

• Tissue plasminogen activator (tPA) medication given as an IV (injected into a vein in your arm)
• An anticoagulant or blood-thinning medicine
• A procedure to open up the blocked artery (thrombectomy)

After treating the blockage, your provider will manage symptoms and/or complications. This may include:

• Inserting and using a feeding tube (if swallowing is difficult)
• Wearing special lenses (prisms) for visual symptoms
• Speech therapy
• Physical therapy
• Occupational therapy

What medications treat Wallenberg syndrome?

If you experience chronic (long-term) pain with Wallenberg syndrome, your healthcare provider might recommend taking gabapentin. This is an anti-seizure medication that may help treat this complication.

Talk to your healthcare provider about any medications or supplements you currently take before starting a new medication. They’ll discuss the possible side effects with you so you can make an informed decision about your health.

Is there a cure for Wallenberg syndrome?

There isn’t a cure available for Wallenberg syndrome at this time. With treatment, you can reduce your risk of complications, especially when diagnosed and treated at the first sign of a stroke.

Can Wallenberg syndrome be prevented?

You can’t prevent all cases of Wallenberg syndrome, but you can reduce your risk by:

• Quitting smoking or not using tobacco products.
• Managing any underlying health conditions.
• Eating well and getting regular physical activity.

What’s the outlook for Wallenberg syndrome?

Your healthcare provider will give you the most accurate information about your outlook. It can vary from person to person, depending on where the damage affects your brainstem and how severe it is.

You may notice your symptoms reduce over several weeks to months and you start to feel more like yourself before the stroke. But a stroke can leave permanent damage and could cause neurological changes that affect your day-to-day functioning. Treatment options are available to help you cope and adapt after a stroke.

When should I see a healthcare provider?

Call 911 or your local emergency services number right away if you or a loved one show signs of a stroke like:

• Difficulty speaking or swallowing
• Problems with balance and coordination
• One-sided sensation changes like numbness or weakness
• Vertigo and dizziness
• Vision changes

What questions should I ask my healthcare provider?

• What caused Wallenberg syndrome?
• What type of treatment do you recommend?
• Are there side effects of the treatment?
• Will there be long-term complications?
• What’s my prognosis?