Abstract
Wallenberg syndrome which is also known as lateral medullary syndrome (LMS) and posterior inferior cerebellar artery syndrome ((PICA syndrome) is detected relatively rarely among young adults. A 42-year-old apparently healthy male presented with headache, vomiting and vertigo. He was diagnosed to have severe hypertension and type-2 diabetes mellitus. During his first admission his first non-contrast computed tomography (NCCT) scan of the brain had confirmed a cerebellar infarction. With clinical findings, the patient was treated as a possible case of LMS. With the repeat NCCT on the third day, he was diagnosed to have progressive cerebellar infarction and a medullary infarction. In the following day the patient was discharged with reserved dates for vertebral artery duplex and ultrasound scan of abdomen (USS). On the seventh day of the illness he had collapsed and died. Subsequent autopsy revealed a left-sided cerebellar and a brain stem infarction along with generalized cerebral oedema. Important findings deduced by forensic pathologists should be conveyed to the clinicians in order to broaden the treatment options and to prevent premature deaths.
Highlights
The clinical importance of cerebellar infarctions is considerable because of the life threatening postinfarction brain stem compression by a postinfarction oedema
The triad of Horner’s syndrome, ipsilateral limb ataxia, and contralateral limb numbness reliably indicated the involvement of vascular territory of Posterior Inferior Cerebellar Artery (PICA) resulting in Wallenberg syndrome/Lateral Medullary Syndrome (LMS)
The first Non Contrast Computed (NCCT) Tomography, brain of the patient showed a left cerebellar infarction and with the second NCCT brain it had progressed to the lateral medulla as well (Fig. 1 A & B)
Summary
The clinical importance of cerebellar infarctions is considerable because of the life threatening postinfarction brain stem compression by a postinfarction oedema. On the second day of admission, he had experienced a left hemi-facial sensory loss, a right upper and lower limb sensory loss with dysphagia, dysarthria, and left sided cerebellar signs. In his medical history he was diagnosed for the first time to have diabetes mellitus and hypertension. No (add internal or external) features of trauma were evident He died before the due date of the vertebral artery duplex scan. The cause of death was determined as cerebral oedema with herniation due to the left cerebellar infarction with PICA syndrome with the probable underlying cause of severe atherosclerotic lesions of the circle of Willis due to uncontrolled hypertension and diabetes mellitus
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