3/14/2023 0 Comments Pica syndrome.The pinprick and temperature loss can extend to the contralateral face when the crossed quintothalamic tract that appends itself medially to the spinothalamic tract is involved. There is decreased pinprick and temperature sensation in the contralateral limbs and body a sensory level may be present on the contralateral trunk with pain and temperature loss on the trunk below that level and in the lower extremity. Feelings of dizziness or instability of the environment may be present examination shows nystagmus with coarse rotatory eye movements when looking to the ipsilateral side and small-amplitude faster nystagmus when looking contralaterally. Sharp jabs of pain are found in the ipsilateral eye and face, and numbness of the face examination confirms decreased pinprick and temperature sensations on the ipsilateral face. Nucleus and descending spinal tract of V. The findings are understood best by reviewing the structures in the lateral medullary tegmentum that are specifically involved. Most often, patients with proximal intracranial vertebral artery occlusive disease present with features of the lateral medullary syndrome. Stenosis is also common just after dural penetration. Most patients with Wallenberg syndrome have residual neurologic deficits months or even years after the acute infarction.Ītherosclerosis of the intracranial vertebral arteries is most severe in the distal portion of the arteries, often at the vertebral-basilar artery junction, sometimes extending into the proximal basilar artery. 117 This so-called lateral pulsion also affects the oculomotor system, producing excessively large saccades directed toward the side of the lesion and abnormally small saccades away from the lesion. Some patients will develop a prominent motor disturbance that causes their body and extremities to deviate toward the lesion side as if being pulled by an invisible force. Hearing loss is not observed because the lesion is caudal to the cochlear nerve entry zone and cochlear nuclei thus, the AICA is not involved. Neurologic examination may reveal an ipsilateral Horner syndrome, ipsilateral dysmetria, dysrhythmia, spontaneous nystagmus, and contra lateral loss of pain and temperature sensation. Characteristic symptoms include vertigo, ipsilateral facial pain, diplopia, dysphagia, and dysphonia. 116 Classic presentation includes sensory deficits affecting the trunk and extremities on the opposite side of the infarct and sensory and motor deficits affecting the face and cranial nerves ipsilateral to the infarct. The syndrome usually results from occlusion of the ipsilateral vertebral artery and rarely from occlusion of the PICA. The zone of infarction producing the lateral medullary syndrome (Wallenberg syndrome) consists of a wedge of the dorsolateral medulla just posterior to the olive ( Fig. Flint MD, FACS, in Cummings Otolaryngology: Head and Neck Surgery, 2021 Lateral Medullary Syndrome
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