WordNet

lying away from the median and sagittal plane of a body; "lateral lemniscus"
situated at or extending to the side; "the lateral branches of a tree"; "shot out sidelong boughs"- Tennyson (同)sidelong
comparative of the adverb `late; "he stayed later than you did"
coming at a subsequent time or stage; "without ulterior argument"; "the mood posterior to" (同)ulterior, posterior
a pattern of symptoms indicative of some disease
a complex of concurrent things; "every word has a syndrome of meanings"
of or relating to the medulla of any body part
containing or consisting of or resembling bone marrow
of or relating to the medulla oblongata
the inner part of an organ or structure in plant or animal

PrepTutorEJDIC

横の,側面の;横からの / (音声が)側音の / 側面,(道路の)側溝(そっこう) / 側音(英語の[1]など)
《補語にのみ用いて》(人などが)(…するのが)『もっと遅い』《+『in』+『名』(do『ing』)》 / (時刻・時期が)『もっと遅い』,もっと後の / 後で,のちほど / (lateの比較級)(定刻・予定時間・他の人(物))より遅れて,遅く
(疾患の徴候となる一群の)症徴候,症候群 / (事件・社会的状態などのパターンを示す)徴候形態
〈U〉骨髄 / =medulla oblongata

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/12/13 05:21:37」(JST)

wiki en

Lateral medullary syndrome (also called Wallenberg syndrome and posterior inferior cerebellar artery syndrome) is a disorder in which the patient has a constellation of neurologic symptoms due to injury to the lateral part of the medulla in the brain, resulting in tissue ischemia and necrosis.

Signs and symptoms

This syndrome is characterized by sensory deficits affecting the trunk (torso) and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. Specifically, there is a loss of pain and temperature sensation on the contralateral (opposite) side of the body and ipsilateral (same) side of the face. This crossed finding is diagnostic for the syndrome.

Clinical symptoms include swallowing difficulty, or dysphagia,^[1] slurred speech, ataxia, facial pain, vertigo, nystagmus, Horner's syndrome, diplopia, and possibly palatal myoclonus.

Affected persons have difficulty in swallowing (dysphagia) resulting from involvement of the nucleus ambiguus, as well as slurred speech (dysarthria) and disordered vocal quality (dysphonia) . Damage to the spinal trigeminal nucleus causes absence of pain on the ipsilateral side of the face, as well as an absent corneal reflex.

The spinothalamic tract is damaged, resulting in loss of pain and temperature sensation on the opposite side of the body. The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms analogous to Horner syndrome.

Nystagmus and vertigo may result in falling, caused from involvement of the region of Deiters' nucleus and other vestibular nuclei. Onset is usually acute with severe vertigo.

Palatal myoclonus may be observed due to disruption of the central tegmental tract.

Clinical B1000 diffusion weighted MRI image showing an acute left sided dorsal lateral medullary infarct

Features

Features of lateral medullary syndrome
Dysfunction	Effects
vestibular nuclei	vestibular system: vomiting, vertigo, nystagmus,
inferior cerebellar peduncle	Ipsilateral cerebellar signs including ataxia, dysmetria (past pointing), dysdiadokokinesia
central tegmental tract	palatal myoclonus
lateral spinothalamic tract	contralateral deficits in pain and temperature sensation from body (limbs and torso)
spinal trigeminal nucleus & tract	ipsilateral loss of pain, and temperature sensation from face
nucleus ambiguus - (which affects vagus nerve and glossopharyngeal nerve - localizing lesion (all other deficits are present in lateral pontine syndrome as well)	ipsilateral laryngeal, pharyngeal, and palatal hemiparalysis: dysphagia, hoarseness, diminished gag reflex (efferent limb - CN.X)
ascending sympathetic fibers	ipsilateral Horner's syndrome (ptosis, miosis, & anhydrosis)

Cause

The three major arteries of the cerebellum: the SCA, AICA, and PICA. (Posterior inferior cerebellar artery is PICA.)

Human brainstem blood supply description. PICA is #12.

It is the clinical manifestation resulting from occlusion of the posterior inferior cerebellar artery (PICA) or one of its branches or of the vertebral artery, in which the lateral part of the medulla oblongata infarcts, resulting in a typical pattern. The most commonly affected artery is the vertebral artery, followed by the PICA, superior middle and inferior medullary arteries.

Treatment

Treatment for lateral medullary syndrome involves focusing on relief of symptoms and active rehabilitation to help those suffering from the stroke syndrome recover their activities of daily living and cope with neurologic loss that can be psychologically devastating. Depressed mood and withdrawal from society can be seen in patients following the initial neurologic insult.

A feeding tube inserted through the mouth or gastrostomy may be necessary if swallowing is impaired. Speech therapy may be beneficial in diet recommendations and helping to understand if there is risk for aspiration pneumonia. In some cases, medication may be used to reduce or eliminate pain. Some studies have reported success in mitigating the chronic neuropathic pain associated with the syndrome with anti-epileptics such as gabapentin. The small caliber of the affected PICA does not typically lend itself to reliable surgical recanalization, although a cerebral angiogram is typically required by a neuroradiologist to make this distinction.^[2]

One of the most unique and difficult to treat symptoms that occur due to Wallenberg syndrome are interminable, violent hiccups. The hiccups can be so severe that patients often struggle to eat, sleep and carry on conversations. Depending on the severity of the blockage caused by the stroke, the hiccups can last for weeks. Unfortunately there are very few successful medications available to mediate the inconvenience of constant hiccups.

Long term treatment generally involves the use of antiplatelets like aspirin or clopidogrel and statin regimen for the rest of their lives in order to minimize the risk of another stroke.warfarin is used if atrial fibrillation is present. Other medications may be necessary in order to suppress high blood pressure and risk factors associated with strokes.

Treatment for this disorder can be disconcerting because some individuals will always have residual symptoms due to the severity of the blockage. Two patients may present with the same initial symptoms right after the stroke has occurred, but after several months one patient may fully recover while the other is still severely handicapped. ^[3]

Prognosis

The outlook for someone with lateral medullary syndrome depends upon the size and location of the area of the brain stem damaged by the stroke. Some individuals may see a decrease in their symptoms within weeks or months. Others may be left with significant neurological disabilities for years after the initial symptoms appeared.^[2]

History

This syndrome was first described in 1808 by Gaspard Vieusseux.^[4] First descriptions by Adolf Wallenberg were in 1895 (clinical) and 1901 (autopsy findings).

References

^ Khedr E, Abo-Elfetoh N (October 2009). "Therapeutic role of rTMS on recovery of dysphagia in patients with lateral medullary syndrome and brain stem infarction". J. Neurol. Neurosurg. Psychiatr. 81 (5): 495–499. doi:10.1136/jnnp.2009.188482. PMID 19828479.
^ ^a ^b wallenbergs at NINDS
^ http://www.healthline.com/galecontent/wallenberg-syndrome
^ synd/1778 at Who Named It?

External links

Lateral Medullary Syndrome or Wallenberg Syndrome| Medchrome
-831848439 at GPnotebook
Department of Biomedical Engineering at Johns Hopkins University
MRI of Lateral Medullary Infarction (Wallenberg) MedPix Images

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 後方循環系の脳血管症候群 posterior circulation cerebrovascular syndromes
2. ホルネル症候群 horners syndrome
3. 回転性めまいの病態生理、病因、および鑑別診断 pathophysiology etiology and differential diagnosis of vertigo
4. 感覚消失患者へのアプローチ approach to the patient with sensory loss
5. 特発性脳動脈および頚動脈の解離：臨床的特徴および診断 spontaneous cerebral and cervical artery dissection clinical features and diagnosis

English Journal

Facial macrosomatognosia and pain in a case of Wallenberg's syndrome: Selective effects of vestibular and transcutaneous stimulations.

Rode G, Vallar G, Revol P, Tilikete C, Jacquin-Courtois S, Rossetti Y, Farnè A.SourceINSERM U1028, CNRS UMR5292, Lyon Neuroscience Research Centre, ImpAct Team, F-69000 Lyon, France; University UCBL Lyon 1, F-69000 Lyon, France; Hospices Civils de Lyon, Hôpital Henry Gabrielle, Mouvement et Handicap, F-69000 Lyon, France.
Neuropsychologia.Neuropsychologia.2011 Nov 29. [Epub ahead of print]
Macro- and micro-somatognosia refer to rare disorders of the cerebral representation of the body whereby patients perceive body parts as disproportionately large or small. Here we report the experimental study of a patient who, following a left lateral medullary stroke (Wallenberg's syndrome, includ
PMID 22142667

[Elastic stable intramedullary nailing after corrective osteotomy of symptomatic malunited midshaft clavicular fractures.]

Smekal V, Attal R, Dallapozza C, Krappinger D.SourceUniversitätsklinik für Unfallchirurgie und Sporttraumatolgie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich, vinzenz.smekal@uki.at.
Operative Orthopadie und Traumatologie.Oper Orthop Traumatol.2011 Oct 26. [Epub ahead of print]
OBJECTIVE: To restore alignment and length of the clavicle, to relieve typical symptoms of malunion, and to improve functional outcome and aesthetic results.INDICATIONS: Symptomatic malunion after clavicular fractures, including local pain and tenderness, weakness and rapid fatigability of the shoul
PMID 22037621

Japanese Journal

症例報告片側Wallenberg症候群により亜急性期に中枢性低換気をきたした1例

菅原恵梨子,齊藤麻美,岡本光生 [他]
臨床神経学 = Clinical neurology 54(4), 303-307, 2014-04
NAID 40020055476

Hemorrhagic Wallenberg Syndrome

Ueda Masayuki,Nishiyama Yasuhiro,Abe Arata,Katayama Yasuo
Internal Medicine 52(20), 2383-2384, 2013
NAID 130003383669

Tilt illusion後に回転性めまいが生じたmegadolichovertebrobasilar anomaly3症例

横田淳一,霜田里絵
Equilibrium Research 72(2), 83-90, 2013
… This rare phenomenon has been reported to occur with pathologic lesions involving the lateral medullary syndrome (Wallenberg's syndrome) or the transient vertebrobasilar ischemia, less commonly cerebral or cerebellar lesions. … MRI findings in each case disclosed compression of the lateral medulla by dolichoectatic vessels. …
NAID 130003372594

Related Pictures

★リンクテーブル★

リンク元	「ワレンベルグ症候群」「外側髄症候群」
関連記事	「lateral」「medullary」「medulla」「syndrome」

「ワレンベルグ症候群」

Lateral medullary syndrome
	Classification and external resources
	Medulla oblongata, shown by a transverse section passing through the middle of the olive. (Lateral medullary syndrome can affect structures in upper left: #9, #10, #11, #12, #13, and #14.)
ICD-10	G46.4
DiseasesDB	10449
eMedicine	emerg/834
MeSH	D014854

　　[★]

英: Wallenberg's syndrome, Wallenberg syndrome
同: ワレンベルグ症候群、Wallenberg症候群; 延髄外側症候群 lateral medullary syndrome LMS
関: 後下小脳動脈血栓、橋延髄外側症候群

[show details]

ワレンベルク症候群 : 約 1,400 件
ワレンベルグ症候群 : 約 14,700 件

表：BET.235(脳神経を侵す脳幹障害)
図：BET.370,376 N.159(自律神経),164(脊髄の動脈)

障害部位：5, 8(vestibular n.), 9, 10, Sympathetic, Cerebellar, Lateral spinothalamic tract

疫学

若年に多く、椎骨動脈の解離が原因であることが多い。

病因

椎骨動脈血栓(VA)、後下小脳動脈血栓(PICA)

障害部位

see BET.376

延髄外側

脊髄視床路：　⇒　対側の体幹・上下肢の温度・痛覚消失　　　　・・・外側脊髄視床路
交感神経下行路：　⇒　同側のホルネル症候群
三叉神経(CN V)：脊髄路核　⇒　同側の顔面の温度・痛覚消失(感覚解離)、角膜反射低下
迷走神経(CN X)：疑核、孤束核？、背側核？　⇒　同側の嚥下障害、発声困難
小脳半球、下小脳脚、オリーブ核小脳路、脊髄小脳路(腹側脊髄小脳路、背側脊髄小脳路)：　⇒　同側の小脳運動失調、筋緊張低下

症状

全身：頭痛、回転性めまい、悪心・嘔吐
同側：顔面の温度・痛覚消失(感覚解離)、角膜反射低下、ホルネル症候群、眼振(回旋性眼振)、眼球側方突進、発声困難、嚥下困難、小脳性運動失調、筋緊張低下
対側：体幹・上下肢の温度・痛覚消失