Thus, the problem of dysphagia in patients with WS is important from 2 perspectives. However, in some patients, dysphagia does not recover for many months, even years. It has been widely accepted that in most cases the dysphagia in WS is initially severe enough to require no oral feeding but often improves rapidly, and the patient can return to oral feeding within 1 to 2 months after the stroke. Īmong these symptoms and signs, dysphagia has been reported in 51% to 94% of the patients with WS. Although the combinations of the various signs and symptoms are helpful for the clinical diagnosis of WS, the presence of the different signs and symptoms may vary from patient to patient. The WS and LMI are easily diagnosed on the basis of the specific neurological findings, but pathological verification may usually be lacking because the LMI is rarely fatal. Wallenberg’s syndrome (WS) is well defined clinically, and the lateral medullary infarction (LMI) is the most frequent cause, among others Figure 2. Patient was discharged with nasogastric tube and follow up at neurology clinic. In addition to lopidogrel 75 mg/day, angiotensin converting enzyme inhibitors (ACEI) for blood pressure control. Patient was put on LIORESAL 25 MG three times/day, Phenergan (Antihistaminic) twice/day to control hiccup. MRI brain was asked showed acute lacunar infarctions of the lateral and posterior aspects of the right side of the medulla and posterior inferior aspect of the right cerebellar hemisphere (PICA TERRITORY) Figure 1.ĭue to dysphagia nasogastric tube was inserted. On examination horizontal nystagmus was detected, true bulbar palsy (injury of bulbar cranial nerves) with dysphagia mainly to fluids, nasal phonation of voice. Neurologist was asked to see the patient. Patient was put on proton pump inhibitors, metoclopramide, yet hiccup didn’t stop. Investigations: no apparent cause was detected. After full examination and evaluation including x-ray chest and abdomen, full lab. Patient was referred to the gastroenterologist to assess the reason for this hiccup. The most commonly affected artery is the vertebral artery, followed by the PICA, superior middle and inferior medullary arteries.Ī male patient 37 years old, hypertensive presented to ER of the hospital by persistent hiccup after lunch. It is the clinical manifestation resulting from occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts, resulting in a typical pattern. Lateral medullary syndrome (also called Wallenberg syndrome and posterior inferior cerebellar artery syndrome) is a disorder in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis.Ĭlinical symptoms include swallowing difficulty, or dysphagia, slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner’s syndrome, diplopia, and possibly palatal myoclonus. Hiccup, Lateral Medullary Syndrome, Stroke Ethical committee has approved this case after taking consent from the patient and explaining to him the importance of the case in clinical practice. The case study is aimed at providing a more thorough analysis of a case of lateral medullary syndrome presented only with persistent hiccup after eating lunch the study hopes to generate an interest for further studies into the topic and focuses on abnormal unusual presentations of lateral medullary syndrome. Received 31 March 2015 accepted 6 June 2015 published 9 June 2015 This work is licensed under the Creative Commons Attribution International License (CC BY). ISBN 9780521878135.1Department of Neurology, GMCH & RC, Ajman, United Arab EmiratesĢDepartment of Clinical Pharmacology, GMCH & RC, Ajman, United Arab EmiratesģDepartment of Radiology, GMCH & RC, Ajman, United Arab EmiratesĤDepartment of Internal medicine, GMCH & RC, Ajman, United Arab EmiratesĥGulf Medical University (GMU), Ajman, United Arab EmiratesĮmail: © 2015 by authors and Scientific Research Publishing Inc. Cerebellar Disorders: A Practical Approach to Diagnosis and Management. In Schwab, Stefan Hanley, Daniel Mendelow, A. Oxford Textbook of Stroke and Cerebrovascular Disease. "Diagnosis and initial management of cerebellar infarction". "Cerebellar infarction: Natural history, prognosis, and pathology". ![]() "Functional recovery after rehabilitation for cerebellar stroke". "Dysarthria in acute ischemic stroke: Lesion topography, clinicoradiologic correlation, and etiology".
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