If swallow impairment goes on for over 2 weeks then a PEG may allow earlier discharge.Aspirin 300 mg for 14 days with a PPI if needed.I have certainly thrombolysed people with the syndrome with loss of swallow (but a borderline NIHSS) which is often one of the most disabling features. Often the NIHSS under reports the disability. Some may rarely have respiratory distress and apnoea and may need intubation and ventilation. MRA/CTA may be done to assess vasculature or if dissection suspected.MRI is diagnostic and the lesion should be visible but can be missed if not actively looked for or the MR has not gone low enough.Opalski felt that weakness was due to ischaemia of the lateral medulla to the upper cervical cord involving corticospinal fibres caudal to pyramidal decussation. Aetiological clues: Neck pain/trauma with dissection, AF, HTN, smoking, alcohol.Hiccups: May be a vagal mediate phenomenom.Contralateral reduced arm/trunk/leg sensation to pain and temperature : Spinothalamic tract.Ipsilateral reduced facial sensation to pain and temperature: Descending nucleus of V.Ipsilateral hemiparesis (Opalski syndrome).Horner's syndrome: Small pupil and mild ptosis on same side as lesion.Ipsilateral Ataxia/Dysmetria/Truncal/Dysarthria instability: Lateral cerebellum or inferior cerebellar peduncle.
Sudden loss of swallow (Nucleus Ambiguus).Cardioembolism, Atherosclerosis, Dissection, moyamoya disease etc.Occlusion of small lateral medullary perforators.Occlusion of Posterior inferior cerebellar artery (PICA).Medulla packed with important long fibre tracts.Aetiologies can be mixed and varied small and large vessel.Opalski syndrome (1946) is considered a variant of Wallenberg syndrome with ipsilateral hemiparesis.Named after Adolf Wallenburg a German in 1895 but was first described in 1808 by Gaspard Vieusseux.All arterial strokes produce vascular syndromes and Lateral Medullary syndrome is no exception.Diagnose Lateral Medullary syndrome and neuroclinical correlation.Reversible Cerebral Vasoconstriction Syndrome.Progressive multifocal leukoencephalopathy.Posterior reversible encephalopathy syndrome.Clinical Syndromes of Vessel occlusion D.Acute disseminated encephalomyelitis (ADEM) B.
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