Wallenberg Syndrome (Posterior Inferior Cerebellar Syndrome)

a. Mnemonic: DAD is Very Loving and Honest

DAD V L H

Dysphagia

Ataxia

Dysphonia

Vertigo, nausea, vomiting

Loss of pain and temperature ipsilateral face (since link 3 below for explanation of why presentation is ipsilateral) and contralateral limbs

Horners syndrome

b. Nuclei and Pathways Disrupted:

1. Oculosympathetic Pathway2. Descending tract and nucleus of the trigeminal nerve3. Nucleus Ambiguus4. Spinothalamic tract - spinothalamic fibres decussate in spinal cord prior to ascending to the brain so effects are contralateral. 5. Ipsilateral vertibular nuclei

c. Effect of Disruption:

1. IPSILATERAL Horners syndrome (Anhidrosis, Miosis, Ptosis) (Quick mnemonic PAM is Horny; PAM = Ptosis, Anhidrosis, Miosis)2. IPSILATERAL facial hypoalgesia (decreased pain) and thermoanaesthesia (decreased temperature).3. IPSILATERAL dysphagia and dysphonia due to vocal cord paralysis.4. CONTRALATERAL trunk and extremity hypoalgesia (decreased pain) and thermoanaesthesia (decreased temperature).5. Vertigo and nystagmus.

USEFUL LINKS

1. Blood supply to the cerebellum (second and third figures are particularly relevant). http://missinglink.ucsf.edu/lm/ids_104_cerebrovasc_neuropath/Case4/CerebralArteryDistribution.htm2. Oculosympathetic pathway: http://eyes.gp-surgery.com/red-flag-topics/horners-syndrome/3. Trigeminal system http://library.med.utah.edu/diganat/SOM/dental.neuro/05%20Trigeminal%20system%202013.pdf