Eccles Health Sciences Library, University of Utah, 10 N 1900 E, SLC, UT 84112-5890Ĭopyright 2018. There are prominent neuro-ophthalmic findings in a patient with Wallenberg syndrome and is usually caused by compromise of the posterior inferior cerebellar artery (PICA) leading to infarction. The structures affected by the infarction in the lateral medulla include the vestibular nuclei, inferior cerebellar peduncle, descending sympathetic pathways, and lateral spinothalamic tract (Figure 5). Axial MRI of the brain showed a hyperintensity on DWI in the right lateral medulla and a corresponding hypointensity on the ADC map consistent with an acute infarction of the right lateral medulla (Figure 4). Dilated fundus examination revealed excyclotorsion of the right eye and incyclotorsion of the left eye (Figure 3). HINTS included horizontal head impulse test, nystagmus and test of skew, which indicated the importance of specific physical examinations 102, 103. The PICA supplies many brain tumors and can be used in intracerebellar chemotherapy. 1-4 Here we report a lady who presented with bilateral cerebellar infarctions in the medial PICA territories and discuss the possible causes of such a. The patient's eyes were deviated to the right during eyelid closure, demonstrating ocular lateropulsion (Video 1). VA terminating in PICA probably cause Bow hunters syndrome (BHS). He had gaze-evoked nystagmus only on right gaze, hypermetric saccades to the right, hypometric saccades to the left, and a left hypertropia that improved with right head tilt and worsened with left head tilt. External examination showed right ptosis and miosis indicating a right Horner syndrome (Figure 1). Although old or recent infarcts of a cerebellar hemisphere in the territories of the posterior inferior (PICA), superior, or anterior inferior cerebellar arteries are commonplace autopsy findings, in no case have corresponding clinical symptoms been clearly identified. Micieli, MD, Department of Ophthalmology, Emory University School of Medicine Valérie Biousse, MD Departments of Ophthalmology and Neurology, Emory University School of MedicineĪ 55-year old man presented with acute onset right-sided facial numbness, left-sided body numbness, vertigo, right ptosis, and binocular vertical diplopia. The cause of this syndrome is usually the occlusion of the posterior inferior cerebellar artery (PICA) at its origin. Lateral Medullary Syndrome Wallenberg Syndrome Horner's Syndrome Skew Deviation Lateropulsion Nystagmus Ocular Tilt Reaction Right Lateral Mediullary Syndrome (Wallenberg Syndrome) With Lateropulsion and Ocular Tilt Reaction
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