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Wallenberg Syndrome (PICA Syndrome)

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Wallenberg Syndrome (PICA Syndrome)

Wall-bird
Mari_navia54360
12 KEY FACTS
PATHOPHYSIOLOGY
Compromise of PICA
PIC(k)-CAn

Wallenberg Syndrome, also called Lateral Medullary Syndrome, arises from compromise to the posterior inferior cerebellar artery, or PICA.

Lateral Medullary Ischemia
Ladder Medusa Ice-ski-mask

Because of the territory irrigated by PICA, the region affected in a stroke of this artery is the lateral medulla. As such, the affected structures are the vestibular nuclei, the trigeminal nuclei, the spinothalamic tract, the nucleus ambiguus, the inferior cerebellar peduncle, and the descending sympathetic fibers

CLINICAL FEATURES
Vertigo
Vertigo-vortex

The compromise of the vestibular nuclei in lateral medullary syndrome can cause vertigo.

Nystagmus
Nostradamus

The compromise of the vestibular nuclei in lateral medullary syndrome can cause nystagmus.

Nausea and Vomiting
Vomiting

Compromise of the vestibular nuclei can cause nausea and vomiting.

Loss of Pain and Temperature in the Ipsilateral Face
No-sign Pain-bolts and Thermometer on One-side of Face

The compromise of the trigeminal nuclei causes loss of pain and temperature sensations in the ipsilateral side of the face.

Loss of Pain and Temperature Sensation in the Contralateral Limbs
No-sign Pain-bolt and Thermometer on Opposite-side Limbs

Compromise of the spinothalamic tract causes loss of pain and temperature sensation in the contralateral side of the trunk and extremities.

Dysphagia
Dice-fajita

Because the nucleus ambiguus houses motor neurons for cranial nerves IX and X, its compromise can cause dysphagia.

Dysarthria and Dysphonia
Slurred Speech-Bubble and Hoarseness

Because the nucleus ambiguus houses motor neurons for cranial nerves IX and X, its compromise can cause dysarthria and dysphonia.

Loss of Gag Reflex
No-sign Gagging

When the nucleus ambiguus is affected, there is a loss of the gag reflex.

Ipsilateral Horner Syndrome
Horny Pam

When the descending sympathetic fibers are affected in Wallenberg Syndrome, Ipsilateral Horner Syndrome is seen.

Ipsilateral Ataxia and Dysmetria, as well as Dysdiadochokinesia
One-side A-taxi with Broken-ruler and Broken-moving-kite

Damage to the inferior cerebellar peduncle causes ipsilateral ataxia and dysmetria. It also causes dysdiadochokinesia, the inability to perform rapid, alternating muscle movements such as closing and opening the fists.

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