Klinische und angiographische Befunde bei vasculären Oblongatasyndromen

Abstract

Eleven cases presenting a syndrome of the medulla oblongata are discussed with reference to the findings of clinical and angiographic investigation. The diagnosis of Wallenberg's syndrome is justified when the classic symptoms are apparent (Horner's syndrome, nystagmus, dysphonia and dysphagia, ataxia, ipsilateral sensory impairment of the face and contralateral elsewhere, and accompanying vegetative disturbances). If additional symptoms such as a facial or extra-ocular muscle paresis, especially hemiparesis, exist, another, more lateral or medial, syndrome of the oblongata should be considered. Angiographic findings vary considerably, ranging from a normal vertebral artery or posterior inferior cerebellar artery (PICA) to an occlusion of these arteries (in three and two of the 11 cases respectively). Modification are often seen in the anterior inferior cerebellar artery (AICA). A kind of complementary supply in the PICA-AICA region must occasionally exist. Localised processes affecting these vessels rather than diffuse multifocal vascular processes would lead to Wallenberg's syndrome. It is difficult to conclude from the clinical picture where a possible responsible vascular narrowing or obliteration may lie, even if pareses of the limb were present.