Wallenberg Syndrome secondary to bilateral vertebral artery dissection and thrombosis

Abstract

The Wallenberg syndrome or lateral medullar syndrome (LMS) is also known as posterior inferior cerebellar artery syndrome. It‘s a  dangerous affection because of his gravity for vital prognostic by the paralysis of cranial nerves. Occlusion of these vessels may be due to stenosis from arteriosclerosis/emboli or arterial dissection. The artery dissection may be spontaneous or after trauma is an important and often treatable cause of the stroke in younger people. The Magnetic Resonance Imagine diffusion weighted inversion (MRI-DWI), the  Magnetic Resonance Angiography (MRA) sequence FAT/SAT and the computed tomography (CT) angiography of the brain allow quickly to the diagnosis. The antithrombotic treatment (antiplatelet drug) and low-molecular weight heparins allow to reduce the neurological  sequelea. So we report two cases of Wallenberg‘s syndrome caused by spontaneous bilateral vertebral dissection and vertebral thrombosis and their clinical, prognostic and therapeutic aspects. A 34-years-old woman, no cardiopathy factors only obesity, no trauma, admitted for acute vomiting, vertigo, neck pain and weakness earlier in themorning and MRA FAT/SAT showedbilateral vertebral artery dissections without an evident posterolateral medulla infarct on MRI-DWI. A 48-year-old man, cumulated cardiopathy factors risks,  admitted with sudden vertigo, disequilibrium and neck pain. The MRI-DWI showed an acute left posterolateral medulla infarct and the CT angiography revealed thesevere left vertebral artery thrombosis. They were treated by the antithrombotic drugs (antiplatelet drugs) and low-molecular weight heparins. In front of a sudden neck pain and vertigo, think about Wallenberg‘s syndrome and do quickly an imaging.

French title: Syndrome de Wallenberg secondaire a une thrombose et une dissection vertebrale bilaterale