Symptoms
The symptoms of lateral medullary syndrome can vary in severity and presentation from person to person. Common symptoms include:
Ipsilateral (same side as the lesion):
Loss of pain and temperature sensation in the face
Horner's syndrome (drooping eyelid, constricted pupil, decreased sweating)
Dysphagia (difficulty swallowing)
Hoarseness
Ataxia (loss of coordination)
Vertigo
Nystagmus (involuntary eye movements)
Contralateral (opposite side of the lesion):
Loss of pain and temperature sensation in the body (below the head) Other possible symptoms: nausea, vomiting, hiccups, dizziness, impaired speech (dysarthria), and altered taste sensation.
Causes
The most common cause of lateral medullary syndrome is a stroke affecting the vertebral artery or the posterior inferior cerebellar artery (PICA). These arteries supply blood to the lateral medulla. The stroke can be caused by:
Thrombosis: Formation of a blood clot within the artery.
Embolism: A blood clot or other material that travels from another part of the body and blocks the artery.
Arterial dissection: A tear in the wall of the artery.
Less common causes: Trauma, fibromuscular dysplasia, or other vascular conditions.
Medicine Used
Treatment focuses on managing the symptoms and preventing further strokes. There is no specific cure for the syndrome itself. Medications commonly used include:
Antiplatelet agents: (e.g., aspirin, clopidogrel) to prevent blood clot formation.
Anticoagulants: (e.g., warfarin, heparin, direct oral anticoagulants (DOACs)) may be used in specific cases to prevent further clot formation.
Pain relievers: For managing pain.
Anti-nausea medications: To control nausea and vomiting.
Muscle relaxants: to help with muscle spasms.
Speech therapy: Assistance with swallowing and speech difficulties.
Physical and occupational therapy: To improve balance, coordination, and strength.
Is Communicable
No, lateral medullary syndrome is not communicable. It is not caused by an infection or contagious agent and cannot be spread from person to person.
Precautions
Precautions after a lateral medullary syndrome event focus on preventing further strokes and managing symptoms:
Medication adherence: Taking prescribed medications as directed.
Lifestyle modifications: Maintaining a healthy diet, exercising regularly, quitting smoking, and managing blood pressure and cholesterol levels.
Fall prevention: Addressing balance and coordination problems to prevent falls.
Swallowing precautions: Following dietary recommendations to prevent aspiration (food or liquid entering the lungs).
Regular medical follow-up: Monitoring for any changes in symptoms or new complications.
How long does an outbreak last?
Lateral medullary syndrome is not an outbreak. It is a stroke caused by a vascular event. The acute phase, which is when symptoms are the most severe, typically lasts for a few days to weeks. Recovery can take months to years and may be incomplete, leaving some individuals with long-term disabilities.
How is it diagnosed?
Diagnosis typically involves:
Neurological Examination: Assessing symptoms and neurological function.
MRI of the brain: This is the most sensitive imaging technique to visualize the infarct (stroke) in the lateral medulla.
CT scan of the brain: May be used initially, but MRI is preferred for better visualization.
Vascular imaging: CT angiography (CTA) or MR angiography (MRA) to evaluate the vertebral and basilar arteries.
ECG and cardiac monitoring: To rule out cardiac causes of stroke.
Timeline of Symptoms
The onset of symptoms is typically sudden, as with any stroke.
Acute Phase (Days to Weeks): Initial onset of symptoms, which can include vertigo, nausea, vomiting, dysphagia, hoarseness, facial sensory loss, and imbalance. Symptoms are usually most severe during this phase.
Subacute Phase (Weeks to Months): Gradual improvement in some symptoms may be seen as the brain attempts to compensate. Physical, occupational, and speech therapy are crucial during this time.
Chronic Phase (Months to Years): Some symptoms may persist long-term, while others may resolve completely. The degree of recovery varies greatly. Management focuses on adapting to any residual deficits.
Important Considerations
Prognosis: The prognosis varies depending on the severity of the stroke and the individual's overall health. Some individuals make a good recovery, while others may have long-term disabilities.
Swallowing difficulties: Dysphagia can lead to aspiration pneumonia, a serious complication.
Pain: Chronic pain can be a significant problem.
Psychological impact: Stroke can have a significant impact on mood and cognitive function. Depression and anxiety are common.
Rehabilitation: Early and intensive rehabilitation is crucial for maximizing recovery.
Secondary stroke prevention: Controlling risk factors such as high blood pressure, high cholesterol, and smoking is essential to prevent future strokes.