![]() ![]() There was no history of weakness, loss of sensation in any limb, loss of consciousness, altered sensorium, behaviour abnormalities, involuntary movements, up-rolling of eyeball, urinary incontinence, faecal incontinence, head, spinal trauma, palpitations, chest pain, or breathlessness. On the way to emergency room, she developed partial closing of right eyelid. Though, she was able to understand the spoken words and sentences, so could identified objects and was able to write. She also developed choking sensation and severe bouts of cough as she tried to drink water.Īfter one hour, she experienced difficulty in speaking and was not in a position to speak any sentence. When she woke up again, she felt numbness and tingling sensation over right side of face along with persistent headache and dizziness. She also took one tablet betahistine 16 mg for dizziness and remained in bed till 6 am. Patient denied development of any weakness in any part of her body. When she tried to get out of bed, she felt dizzy and was unable to balance herself and had tendency to fall towards right side. Patient tried to sleep despite her headache but was unable to do so. Pain was not relieved by ibuprofen 400 mg. The intensity of pain was 6/10 on numeric pain scale and more marked over right occipital region. Detailed discussion of these variants is beyond the scope in this article.Ī 49-year-old Indian female having a history of primary hypothyroidism presented to us within 6 hours of onset of symptoms with a history of sudden onset right hemicranial headache that woke her from sleep at around 4 am. In actual clinical practice LMS may manifest not all but few of the aforementioned clinical features and also some atypical clinical manifestations which are commonly referred to variants of LMS due to involvement of different neuroanatomical structures. Finally, involvement of ascending sympathetic fibres is associated with development of ipsilateral Horner’s syndrome. Vestibular nuclei involvement causes nystagmus and vertigo. Ataxia denotes damage to cerebellum or inferior cerebellar peduncle. Presence of dysphagia and dysarthria suggest involvement of nucleus ambiguous. Absence of ipsilateral corneal reflex suggest involvement of spinal trigeminal (Vth cranial nerve) nucleus. The most characteristic symptom of LMS include loss of pain and temperature sensation on ipsilateral face and contralateral side of rest of the body. It occurs due to the involvement of lateral segment of medulla either caused by thrombotic or embolic occlusion of vertebral artery or posterior inferior cerebellar artery (PICA) or due to vertebral artery dissection due to neck injury/chiropractic manipulation. Lateral medullary syndrome (LMS) was first described by Gaspard Vieussux in 1808 and the first clinical description of this syndrome was given by Wallenberg in 1895. ![]()
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