Lateral Medullary Infarction Research Articles

Hemorrhagic Wallenberg Syndrome Accompanied by Horner Syndrome at Young Age

Highlight: Wallenberg syndrome caused by medulla oblongata hemorrhage with good functional outcome. Wallenberg syndrome is accompanied by Horner's syndrome, which occurs at a young age. In patients with Wallenberg syndrom, conservative management and medical rehabilitation are used. ABSTRACT Introduction: Wallenberg syndrome is a rare syndrome involving the medulla oblongata, an uncommon hemorrhage site. It is also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome. Wallenberg syndrome has several symptoms that can be divided into vestibulo-cerebellar, bulbar, autonomic, sensory, and atypical. Case: A 27-year-old man came to the emergency unit complaining of dizziness and swinging, as well as a left eyelid that did not open completely, a lack of sweat on the left side of the face, a hoarse voice, swallowing disturbances, hiccups, decreased hearing in the left ear, and a lack of sensation on the left side of the face and the right side of the body. The patient tended to fall to the left and was unsteady when standing. Physical examination revealed Horner syndrome, bidirectional nystagmus, left dysdiadochokinesia, and left ataxia. A CT scan of the head showed a left-sided medulla oblongata hemorrhage. The patient was given conservative therapy, feeding through a nasogastric tube, and medical rehabilitation. A repeat CT scan of the head was done one week later, and it was discovered that the hemorrhage in the medulla oblongata had begun to absorb. Conclusion: Wallenberg syndrome, with a manifestation of hemorrhagic stroke in the medulla oblongata, can occur at a young age with various clinical symptoms. The diagnosis of Wallenberg syndrome is made based on clinical symptoms and imaging findings. Conservative therapy using medicines and medical rehabilitation can provide a speedy recovery. An incorrect diagnosis is a major hazard to patient safety and can have serious consequences, including permanent disability or death.

Solely Ultrasound-guided Botulinum Toxin Injection in the Cricopharyngeus Muscle: Successful Treatment in a Patient of Chronic Dysphagia Following Lateral Medullary Syndrome

Botulinum toxin (BTX) injection is a widely used procedure for the treatment of the dysfunction of the upper oesophageal sphincter. Although injection can be guided by ultrasound (US), electromyography or computed tomography, the most convenient option will be solely US-guided injection. No studies yet observed the effectiveness of solely US-guided BTX injection in the cricopharyngeus muscle (CPM) in dysphagia following lateral medullary syndrome (LMS). In this report, 50 U of BTX type-A was given in the right CPM in a patient of right LMS with chronic severe dysphagia, under the guidance of US. Dysphagia Outcome Severity Scale score improve from 1 to 6, Functional Oral Intake Scale score improved from 1 to 6 and penetration-aspiration scale score improved from 7 to 2 at 2 months follow-up. Solely US-guided BTX injection may be a feasible option for many rehabilitation units in managing dysphagia following LMS.

Opalski's syndrome: a rare variant of Wallenberg's syndrome

A 54-year-old, right-handed male presented with acute-onset severe headache, vertigo, and vomiting. Initial neurologic examination illustrated dysarthria (lingual), nystagmus (horizontal), left dysmetria on finger-to-nose testing, and weakness of the left upper and lower limb. Magnetic resonance imaging showed left lateral medullary infarction (Wallenberg syndrome). The patient was discharged 3 weeks later to an inpatient treatment with neurorehabilitation facility with gradual improvement of his symptoms.

Acute dysphagia: A rare initial symptom of lateral medullary syndrome: A case report☆

A unique etiology of stroke, lateral medullary syndrome (LMS), is a consequence of posterior inferior cerebellar artery or vertebral artery thromboembolic conditions. LMS patients present particularly with ipsilateral hyperalgesia, ipsilateral ataxia, and Horner's syndrome. Our case signifies that neurogenic origin should always be considered in the absence of local causes of dysphagia. Early diagnosis could prevent LMS complications, including neurological disabilities. A scarcity of research related to dysphagia in LMS, and its outcomes exists. Therefore, the objective is to investigate the clinical course in a patient afflicted with severe dysphagia following a diagnosis of (LMS). This would encourage further research, thus improving management and treatment strategies. We report a case of a 45-year-old male, a smoker for 20 years, who presented with a single, unique complaint of acute dysphagia for 9 days. According to our knowledge, this is among very few reported cases of LMS with dysphagia being the rare initial complaint. The neurological issues associated with dysphagia gradually improved with the administration of antiplatelet; clopidogrel and lipid-lowering drug; rosuvastatin and the patient was discharged. Atypical presentation in LMS could be supported by the presence of lateral medullary infarct which was confirmed by MRI (Magnetic Resonance Imaging). Dysphagia is a common complaint in multiple gastrointestinal (GI) settings. However, in cases where the GI causes are excluded, as described here, diagnosis of LMS becomes tough. The diagnosis of LMS was queried owing to the presentation of the single most important common symptom, with no other characteristic manifestations of LMS.

The diagnostic value of the ocular tilt reaction plus head tilt subjective visual vertical (±45°) in patients with acute central vascular vertigo.

To investigate the localization diagnostic value of the ocular tilt reaction (OTR) plus head tilt subjective visual vertical (SVV) in patients with acute central vascular vertigo (ACVV). We enrolled 40 patients with acute infarction, 20 with unilateral brainstem infarction (BI) and 20 with unilateral cerebellar infarction (CI). We also included 20 patients with unilateral peripheral vestibular disorders (UPVD) as the control group. The participants completed the OTR and SVV during head tilt (±45°) within 1 week of symptom onset. In patients with ACVV, including that caused by lateral medullary infarction (100%, 2/2), partial pontine infarction (21%, 3/14), and cerebellum infarction (35%, 7/20), we observed ipsiversive OTR, similar to that seen in UPVD patients (80.0%, 16/20). Some of the patients with medial medullary infarction (50%, 1/2), partial pons infarction (42%, 6/14), midbrain infarction (100%, 2/2), and partial cerebellum infarction (30.0%, 6/20) showed contraversive OTR. The skew deviation (SD) of the BI group with ACVV was significantly greater than that of the UPVD group (6.60 ± 2.70° vs. 1.80 ± 1.30°, Z = -2.50, P = 0.012), such that the mean SD of the patients with a pons infarction was 9.50° and that of patients with medulla infarction was 5.00°. In ACVV patients with no cerebellar damage, the area under the curve of the receiver operating characteristic curve corresponding to the use of SD to predict brainstem damage was 0.92 (95%CI: 0.73-1.00), with a sensitivity of 100% and a specificity of 80% when SD ≥ 3°. We found no statistical difference in SD between the UPVD and CI groups (1.33 ± 0.58° vs. 1.80 ± 1.30°, Z = -0.344, P = 0.73). Compared with the UPVD patients, the ACVV patients with a partial pons infarction (43%, 6/14, χ2 = 13.68, P = 0.002) or medulla infarction (25%, 1/4, χ2 = 4.94, P = 0.103) exhibited signs of the ipsiversive E-effect with the contraversive A-effect, while those with a partial medulla infarction (50%, 2/4), pons infarction (43%, 6/14), or cerebellar infarction (60%, 12/20) exhibited a pathological symmetrical increase in the E-effect. The evaluation of OTR plus head tilt SVV (±45°) in vertigo patients is helpful for identifying and diagnosing ACVV, especially when SD is ≥ 3° or the E-effect is symmetrically increased.

Lateral medullary syndrome: an unwanted ischemia to identify early

Lateral medullary syndrome also referred to as Wallenberg syndrome, posterior inferior cerebellar artery (PICA) syndrome, or vertebral artery syndrome is a cluster of neurological symptoms and signs brought on by obstructions in the blood vessels supplying the medulla, which causes ischemia or infarction of the brainstem. The vertebral artery or the posterior inferior cerebellar artery are the arteries most frequently affected with lateral medullary syndrome. The most prevalent symptom is transient ischemic attack (TIA) with dizziness or vertigo and atherosclerosis in the posterior cerebral circulation being the most common cause. Lateral Medullary Syndrome patients suffer from strokes or infarction and also present with vomiting, nausea, gait impairment, instability, hoarseness, and swallowing difficulties. Depending on the particular nuclei and fibers involved, different indications will appear. CT/MRI imaging is used to diagnose conditions. The majority of management is supportive, including risk factor reduction for additional ischemia events as well as speech and occupational therapy following an acute intervention. In this review article, we discuss the etiopathogenesis and factors leading to lateral medullary syndrome along with a comprehensive discussion on its clinical features, challenges in diagnosis, and treatment.

Lateral Medullary Syndrome Presenting as Babinski–Nageotte Syndrome with Ipsilateral Upper Motor Neuron Facial Palsy

Babinski–Nageotte syndrome is one of the variants of lateral medullary syndrome (LMS) with contralateral hemiparesis along with classical LMS findings. The simultaneous occurrence of ipsilateral central facial nerve palsy and contralateral hemiparesis is an extremely rare occurrence in LMS. We report the case of a 46-year-old male who presented with complaints of acute onset of vertigo, right-sided (ipsilateral) Horner syndrome, facial sensory loss, upper motor neuron facial nerve palsy, ataxia, and left hemiparesis (contralateral). Magnetic resonance imaging brain suggested acute infarct of the right dorsal medulla and medial aspect of the right cerebellar tonsil with attenuation of the distal segment of the right vertebral artery and right posterior inferior cerebellar artery.

Cricopharyngeal Myotomy; a Rescue Surgery for Dysphagia in Lateral Medullary Syndrome

Lateral medullary syndrome/Wallenberg syndrome, is a neurological disorder occurring due to ischemia in the lateral part of medullary oblongata resulting in wide range of symptoms. Dysphagia is usually exhibited in severe and persistent form in LMS. Hence timely intervention is mandatory before the patient further worsens. We describe a case of Lateral medullary syndrome with persisitent dysphagia who was managed successfully with cricopharyngeal myotomy.

OPALSKI SYNDROME – A RARE VARIANT OF LATERAL MEDULLARY SYNDROME

Lateral medullary syndrome(LMS) also called as Wallenberg syndrome results from a vascular event in the lateral part of medulla oblangata. LMS is charecterised by vertigo ,diplopia , dysarthria,horners syndrome,numbness(ipsilateral face and contralateral limb) and traditionally not associated with any limb weakness. However in Opalski syndrome[1] and Babinski Nageotte syndrome[2],lateral medullary syndrome is asscociated with hemiplegia. Opalski syndrome[1] is an unusual manifestation of lateral medullary syndrome where ipsilateral hemiperesis occurs along with LMS due to involvement of corticospinal tract bres after decussation in medulla.

Vertebral artery dissection induced lateral medullary syndrome characterized with severe bradycardia: a case report and review of the literature

Lateral medullary syndrome is the most common type of brainstem infarction. Lateral medullary syndrome results in damage to the corresponding cranial nerve nuclei and the nucleus tractus solitarius, with vertigo, ipsilateral ataxia, crossed sensory disturbances, Horner's sign, bulbar palsy, and other underlying symptoms or signs. However, cases with cardiac arrhythmia and other autonomic dysfunctions as the primary manifestations are less common. Clinically, sudden death occasionally occurs in patients with lateral medullary syndrome, which may be associated with severe cardiac arrhythmia. These patients may suffer in life-threatening arrhythmia and even cardiac arrest, and vital signs should be closely monitored to prevent sudden death. In younger patients, vertebral artery dissection is the most common cause. Here, we present a case of lateral medullary syndrome caused by vertebral artery dissection with severe bradycardia. The patient was a 49-year-old man who was admitted with "sudden onset of numbness in the left limbs and right side of the face for 1 hour". Electrocardiogram (ECG) monitoring showed a repeated heart rate decrease to as low as 23 beats/min, followed by a gradual increase in heart rate to 35-55 beats/min after 2-3 seconds. Head magnetic resonance imaging (MRI) examination revealed right dorsolateral cerebral infarction of the medulla oblongata. Digital subtraction angiography (DSA) revealed a right vertebral artery dissecting aneurysm. We performed an emergency placement of a temporary pacemaker, followed by conservative treatment with platelet aggregation inhibitors, vascular softening agents and improved collateral circulation. Elective spring coil embolization of the vertebral artery dissecting aneurysm and stent implantation were performed. At outpatient follow-up, the patient had a good prognosis. Clinical management of patients with lateral medullary syndrome should be prioritized, with close cardiac monitoring at the early stages of observation and pacemaker placement and tracheal intubation as required to prevent adverse events.

Clinico-Radiological Profile of Patients With Lateral Medullary Syndrome: A Five Years Observation From a Single-Centered Tertiary Hospital in Nepal.

Objective: We aim to correlate the prevalence of symptoms of the lateral medullary syndrome (LMS) based on radiological classification.Methods: A five-year record of 41 patients diagnosed with LMS and admitted to a tertiary care center in Nepal was reviewed. We used chi-square tests to compare symptoms between rostral and caudal groups and different horizontal subtypes.Results: The subtype prevalence in the horizontal classification of LMS was large (31.7%), lateral (22%), dorsal (19.5%), typical (14.6%), and ventral (12.2%). The most common symptoms in the typical subtype of the horizontal classification were: pain/temperature loss in the contralateral body (7.3%) and dysphagia (7.3%); in the ventral subtype, swaying on the Romberg test (12.2%), dysarthria (9.8%) and dizziness (9.8%); in the dorsal subtype, headache (12.2%) and vomiting (12.2%). Whereas headache (22.2%) and lateropulsion on standing (14.6%), swaying on the Romberg test (14.6%), nausea/vomiting (14.6%) were common in the large subtype, and nausea/vomiting (19.5%) and headache (17.1%) in the lateral subtypes. Whereas, in rostrocaudal classification, the rostral subtype (61%) was more common than the caudal subtype (31%). There was no significant variation in symptoms based on the rostrocaudal classification of LMS.Conclusion: The common clinical manifestations are different for different radiological subtypes of LMS. Further comprehensive studies are essential to understand the prevalence of symptoms in different radiological subtypes and the clinical-radiologic correlation in LMS.

Progression rates of medulla oblongata infarcts in clinical follow-up: A retrospective study

ObjectiveTo determine clinical progression rates in patients with medulla oblongata infarction (MOI). Materials and methodsThe data of patients diagnosed with MOI were analysed retrospectively. Dermographic characteristics of the patients; Age, gender, history and stroke etiology were evaluated. Radiological imagings were reviewed retrospectively. Intensive care unit (ICU) requirement, number of intubation days, failed extubation and death rates, good clinical outcome at discharge and 3 months [modified Rankin Scale (mRS 0–2)] and poor clinical outcome (mRS 3–6) rates were evaluated. In addition, the clinical results of patients with medial medullary infarction (MMI) and lateral medullary infarction (LMI) were compared. Results33 patients were included in the study, 22 (66.7 %) were male. The mean age of the patients was 72.0 (43.0–85.0). The characteristics of the patients (dermographic features, comorbidities, clinical symptoms, infarct localization, etc.) were evaluated. The results of MMI and LMI patients were compared. The intubation rate was 4 (44.4 %) in the MME group, while it was 8 (33.3 %) in the LME group. There was no statistically significant difference between the two groups in terms of failed extubation, tracheostomy, hospitalization and mortality rates. However, while discharge mRS was statistically significant between the two groups, the mRS at 3 months was not statistically significant. Twelve (36.4 %) of all patients were intubated due to severe clinical progression. In the clinical follow-up, 6 (50.0 %) of the intubated patients died, 3rd month mRS of 6 (50.0 %) patients who survived was 5. In all patients 3-month good clinical outcome rate was % 48,5. ConclusionIt should not be forgotten that life-threatening clinical progressions may develop at a considerable rate during the early treatment process of patients diagnosed with MOI.

Pain Mimicking Trigeminal Neuralgia in Patients with Acute Ischemic Stroke of the Brainstem

Background and PurposeCases of pain mimicking trigeminal neuralgia (TN) induced by ischemic stroke in the brainstem have been sparsely reported. The study was to determine the characteristics of symptomatic TN in patients with acute ischemic stroke in the medulla oblongata and pons, and to determine the location of the ischemic lesion associated with the pain.Patients and MethodsA total of 6/21 (28.5%) patients with medullary ischemic stroke and 3/34 (8.8%) patients with pontine ischemic stroke who experienced pain mimicking TN between 1 week before and 2 weeks after the stroke onset were enrolled in the study. All patients accepted neuroimaging examinations to determine the location of the ischemic lesion and the etiology of ischemic stroke. The characteristics of pain were recorded and analyzed.ResultsIschemic lesions of patients who experienced pain mimicking TN were located in the lateral medulla oblongata (n=6), nerve root entry zoo (n=2), and areas involved with the spinal trigeminal tract (n=1) in the pons. Half of the instances of pain induced by medullary ischemic stroke occurred prior to the stroke onset. The branch of V1 was exclusively involved in patients with lateral medullary infarction and the branches of V2 and V3 were typically involved in patients with pontine infarction. The pain was relieved spontaneously (n=4, 44.4%) or was controlled with drugs for neuropathic pain treatment (n=5, 55.5%).ConclusionHalf of the instances of pain induced by medullary ischemic stroke occurred prior to the stroke onset. Pain mimicking TN might be a premonitory symptom of the medullary ischemic stroke. Pain mimicking TN induced by brainstem infarction has a good prognosis.

Central Horner Syndrome with Vertebral Artery Dissection

Purpose: To report the first case of a 53-year-old male patient diagnosed with central Horner syndrome, associated with vertebral artery dissection, which has never been reported in Korea to date.Case summary: A 53-year-old male patient presented with conjunctival hyperemia in the left eye for over 4 months, with a past history of acute subarachnoid hemorrhage and ruptured dissecting aneurysm in the left vertebral artery. On slit-lamp examination, mild ptosis of the upper eyelid and conjunctival hyperemia were noted in his left eye. The left pupil was smaller than the right without afferent pupillary defects in either eye. Anisocoria was greater in the dark, and dilation lag was noted in the left pupil. On systemic examination, he complained of numbness in the right upper and lower extremities and symptoms of leaning to the left when walking. After instillation of 0.5% apraclonidine, the anisocoria was reversed, and ptosis and conjunctival hyperemia disappeared. Magnetic resonance images revealed chronic infarction in the left lateral medulla, and he was diagnosed with central Horner syndrome associated with Wallenberg syndrome.Conclusions: We present the first case in Korea of central Horner syndrome associated with lateral medullary infarction caused by vertebral artery dissection.

Challenging the diagnosis of a posterior circulation dissecting aneurysm

I ntracranial vertebral dissections have polymorphs clinical presentations and can lead to haemorrhagic complications if they are intracranial. We here describe a case of a thrombosed dissecting aneurysm of postero-inferior cerebellar artery (PICA) revealed by a Wallenberg syndrome preceded by headaches. A 23-year-old patient, without neurological or vascular past medical history, was admitted for dizziness preceded by headache. The clinical examination on admission revealed an incomplete Wallenberg syndrome, associating hemiface sensitive deficit, Horner's syndrome, dysmetria and nystagmus. The brain MRI showed a latero-medullary infarct with a homolateral PICA thrombosed dissecting aneurysm. The diagnosis of intracranial dissecting aneurysms needs particular caution because aneurysm sac thrombosis can give false reassurance on angiographic MR sequences. Moreover, the anatomic features of intracranial artery walls make them prone to sub-adventitial dissection and subsequent subarachnoid haemorrhages. Therefore, antithrombotic therapy should be used with caution, due to the risk of bleeding in these intracranial dissections.

Diagnostic Performance of High-Resolution Vessel Wall Magnetic Resonance Imaging and Digital Subtraction Angiography in Intracranial Vertebral Artery Dissection.

Purpose: Intracranial vertebral artery dissection (VAD) is being increasingly recognized as a leading cause of Wallenberg syndrome and subarachnoid hemorrhage. Conventional angiography is considered the standard diagnostic modality, but the diagnosis of VAD remains challenging. This study aimed to compare the diagnostic performance of high-resolution vessel wall imaging (HR-VWI) with digital subtraction angiography (DSA) for intracranial VAD. Materials and methods: Twenty-four patients with 27 VADs, who underwent both HR-VWI and DSA within 2 weeks, were consecutively enrolled in the study from March 2016 to September 2020. HR-VWI and DSA were performed to diagnose VAD and to categorize its angiographic features as either definite dissection or suspicious dissection. Features of HR-VWI were used to evaluate direct arterial wall imaging. The reference standard was set from the clinicoradiologic diagnosis. Two independent raters evaluated the angiographic features, dissection signs, and interrater agreement. Each subject was also dichotomized into two groups (suspicious or definite VAD) in each modality, and diagnosis from HR-VWI and DSA was compared with the final diagnosis by consensus. Results: HR-VWI had higher agreement (90.6% vs. 53.1%) with the final diagnosis and better interrater reliability (kappa value (κ) = 0.91; 95% confidence interval (CI) = 0.64–1.00) compared with DSA (κ = 0.58; 95% CI = 0.35–1.00). HR-VWI provided a more detailed identification of dissection signs (77.7% vs. 22.2%) and better reliability (κ = 0.88; 95% CI = 0.58–1.00 vs. κ = 0.75; 95% CI = 0.36–1.00), compared to DSA. HR-VWI was comparable to DSA for the depiction of angiographic features for VAD. Conclusions: HR-VWI may be useful to evaluate VAD, with better diagnostic confidence compared to DSA.

Clinical characteristics of patients with lateral medullary infarction who had fatal respiratory failure

IntroductionRespiratory failure is a fatal complication of lateral medullary infarction (LMI). However, the clinical characteristics associated with respiratory failure in patients with LMI have not been fully elucidated. We aimed to evaluate the clinical characteristics associated with respiratory failure in patients with LMI. MethodsAmong the 6365 consecutive patients who were admitted to our institute within 7 days of onset of acute ischemic stroke between January 2007 and December 2019, we identified those with acute LMI as verified by magnetic resonance imaging. We evaluated the associations between clinical characteristics and fatal respiratory failure that occurred within 10 days of stroke onset. ResultsOf 102 patients with acute LMI, eight had fatal respiratory failure within 10 days of stroke onset. Patients with fatal respiratory failure had a higher premorbid modified Rankin Scale score than did those without (3 vs. 0, p < 0.001), as well as a higher frequency of pulmonary disease (37.5% vs. 2.1%, p = 0.003). Severe dysphagia (100% vs. 30.9%, p < 0.001), dysarthria (100% vs. 56.4%, p = 0.020), ipsilateral hemiparesis (50.0% vs. 5.3%, p = 0.002), and urinary retention (50.0% vs. 2.1%, p < 0.001) were also significantly more common in patients with fatal respiratory failure than in those without. There were no significant differences in infarct locations between patients with fatal respiratory failure and those without. ConclusionsAssessment of pre-stroke history and monitoring of neurological symptoms that occur during the first 10 days post-stroke onset would be useful for predicting the risk of respiratory failure in patients with acute LMI.

Lateral Medullary Syndrome in Patients with Vertebral Artery Dissection: Case Series Illustration and Review of the Neuroanatomical Correlates

Lateral Medullary Syndrome in Patients with Vertebral Artery Dissection: Case Series Illustration and Review of the Neuroanatomical Correlates

Eosinophilic meningitis following suboccipital craniotomy without bovine dural graft: illustrative case.

BACKGROUNDEosinophilic meningitis is a rare known complication after brain surgery associated with duraplasty using artificial bovine graft. However, eosinophilic meningitis after craniotomy without bovine dural graft has not been reported.OBSERVATIONSA 48-year-old female presented with lateral medullary infarction caused by a vertebral artery dissecting aneurysm incorporating the posterior inferior cerebellar artery (PICA). The authors performed occipital artery–PICA anastomosis and repaired the dura by primary suture without bovine graft. Thereafter, endovascular internal trapping using coils was conducted. Severe headache developed at postoperative day 17, and the patient was diagnosed with eosinophilic meningitis. After administration of a high-dose corticosteroid for 2 weeks, her symptoms and laboratory findings were improved.LESSONSPostoperative eosinophilic meningitis is rarely related to craniotomy without using bovine graft. Neurosurgeons should consider the possibility of eosinophilic meningitis after craniotomy without a xenogeneic dural material.

Opalski syndrome: A rare presentation of Wallenberg syndrome

Lateral Medullary Syndrome (LMS) is a well studied vascular syndrome of the posterior circulation territory. This syndrome is localised with its typical presentation including vertigo, nystagmus, hoarseness, dysphagia, ipsilateral cerebellar signs and Horner’s syndrome with classical crossed sensory deficits, specifically loss of pain and temperature sensation affecting trunk and extremities contralateral to the infarct along with ipsilateral facial numbness. We present a case of Opalski syndrome which is a rare variant of Wallenberg syndrome, where lateral medullary syndrome is associated with ipsilateral hemiparesis and positive Babinski sign. This case report showcases one of the varied presentation of ipsilateral weakness in Lateral Medullary Syndrome or Wallenberg syndrome.