Wallenberg's syndrome may involve?
Ans. D. All of the above > B. Nucleus ambiguous. (Ref Harrison's 18th / Figure 370-10).# Lateral medullary syndrome (occlusion of any of five vessels may be responsible--vertebral, posterior inferior cerebellar, superior, middle, or inferior lateral medullary arteries)- On side of lesion- Pain, numbness, impaired sensation over one-half the face: Descending tract and nucleus fifth nerve- Ataxia of limbs, falling to side of lesion: Uncertain--restiform body, cerebellar hemisphere, cerebellar fibers, spinocerebellar tract (?)- Nystagmus, diplopia, oscillopsia, vertigo, nausea, vomiting: Vestibular nucleus- Homer's syndrome (miosis, ptosis, decreased sweating): Descending sympathetic tract- Dysphagia, hoarseness, paralysis of palate, paralysis of vocal cord, diminished gag reflex: Issuing fibers ninth and tenth nerves- Loss of taste: Nucleus and tractus solitarius- Numbness of ipsilateral arm, trunk, or leg: Cuneate and gracile nuclei- Weakness of lower face: Genuflected upper motor neuron fibers to ipsilateral facial nucleus- On side opposite lesion- Impaired pain and thermal sense over half the body, sometimes face: Spinothalamic tract.Posterior circulationASALateral corticospinal tract.Medial lemniscus.Caucal medulla--hypoglossal nerve.Contralateral hemiparesis--upper and lower limbs.| contralateral proprioception. Ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally).Stroke commonly bilateral.Medial medullary syndrome- caused by infarct of paramedian branches of ASA and vertebral arteries.PICALateral medulla--vestibular nuclei, lateral spinothalamic tract, spinal trigeminal nucleus, nucleus ambiguus, sympathetic fibers, inferior cerebellar peduncle.Vomiting, vertigo, nystagmus;| pain and temperature sensation from ipsilateral face and contralateral body; dysphagia, hoarseness, | gag reflex; ipsilateral Homer syndrome; ataxia, dysmetria.Lateral medullary (Wallenberg) syndrome.Nucleus ambiguus effects are specific to PICA lesions."Don't pick a (PICA) horse (hoarseness) that can't eat (dysphagia)."AICALateral pons--cranial nerve nuclei; vestibular nuclei, facial nucleus, spiral trigeminal nucleus, cochlear nuclei, sympathetic fibers.Vomiting, vertigo, nystagmus. Paralysis of face, | lacrimation, salivation, | taste from anterior 2/3 of tongue, | comeal reflex. Face--| pain and temperature sensation. Ipsilateral | hearing. Ipsilateral Homer syndrome.Lateral pontine syndrome.Facial nucleus effects are specific to AICA lesions. "Facial droop means AICA's pooped." Middle and inferior cerebellar peduncles.Ataxia, dysmetria. PCAOccipital cortex, visual cortex.Contralateral hemiancpia with macular sparing. Basilar arteryPons, medulla, lower midbrain, corticospinal and corticobulbar tracts, ocular cranial nerve nuclei, paramedian pontine reticularPreserved consciousness and blinking, quadriplegia, loss of voluntary facial, mouth, and tongue movements."Locked-in syndrome."Signs and symptoms of other medullary syndrome: Structures involved# Medial medullary syndrome (occlusion of vertebral artery or of branch of vertebral or lower basilar artery)- On side of lesion- Paralysis with atrophy of one-half half the tongue: Ipsilateral twelfth nerve- On side opposite lesion- Paralysis of arm and leg, sparing face; impaired tactile and proprioceptive sense over one-half the body: Contralateral pyramidal tract and medial lemniscus# Total unilateral medullary syndrome (occlusion of vertebral artery): Combination of medial and lateral syndromes# Lateral pontomedullary syndrome (occlusion of vertebral artery): Combination of lateral medullary and lateral inferior pontine syndrome# Basilar artery syndrome (the syndrome of the lone vertebral artery is equivalent): A combination of the various brainstem syndromes plus those arising in the posterior cerebral artery distribution.- Bilateral long tract signs (sensory and motor; cerebellar and peripheral cranial nerve abnormalities): Bilateral long tract; cerebellar and peripheral cranial nerves- Paralysis or weakness of all extremities, plus all bulbar musculature: Corticobulbar and corticospinal tracts bilaterall.Features of lateral medullary syndrome (Wallenberg syndrome and posterior inferior cerebellar artery syndrome)Dysfunction Effects1Vestibular nucleivestibular system: vomiting, vertigo, nystagmus,2Inferior cerebellar peduncleIpsilateral cerebellar signs including ataxia, dysmetria (past pointing), dysdiadokokinesia3Central tegmental tractpalatal myoclonus4Lateral spinothalamic tractcontralateral deficits in pain and temperature sensation from body (limbs and torso)5Spinal trigeminal nucleus & tractipsilateral loss of pain, and temperature sensation from face6Nucleus ambiguus - (which affects vagus nerve and glossopharyngeal nerve - localizing lesion (all other deficits are present in lateral pontine syndrome as well)ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis: dysphagia, hoarseness, diminished gag reflex (efferent limb - CN.X)7Descending sympathetic fibersipsilateral Horner's syndrome (ptosis, miosis, & anhydrosis)
Vestibular nucleus
Nucleus ambiguus
Nucleus and tractus solitarius
All of the above
C.N.S.