Disclosures: Yulia Rivelis, MD: Nothing to disclose

Case Description: Patient with past medical history of hypertension and fibromyalgia initially presented with acute onset of headaches, left facial numbness, right-sided weakness, ataxia, dizziness, and vomiting. Imaging revealed left medullary infarct. Twenty-four hours later, she began to exhibit hoarseness, hiccups, and dysphagia. Physical exam showed left facial droop with decreased sensation and left tongue deviation. She had decreased pain and temperature sensation throughout her right side but had no significant motor deficits. Patient had severe left truncal lean during ambulation with fair sitting balance. Hospital course was complicated by aspiration pneumonia and patient required PEG tube placement for severe dysphagia. Patient underwent comprehensive rehabilitation treatment with multidisciplinary team involvement.

Setting: Acute stand-alone rehabilitation facility.

Patient: 59-year-old female with Wallenberg Syndrome.

Assessment/Results: Patient showed great improvement throughout her rehab course. Truncal ataxia and ambulation showed significant improvement with physical therapy, and sensory deficits slowly recovered with therapeutic modalities such as electrical stimulation. With speech therapy, her diet was gradually advanced until she no longer required PEG tube feedings and tolerated an oral diet. Patient will still require ENT outpatient follow-up to evaluate her vocal cord weakness.

Discussion: Lateral medullary syndrome, also known as Wallenberg syndrome or posterior inferior cerebellar artery (PICA) syndrome, is a presentation with high morbidity due to a wide variety of symptoms from ischemia in the lateral portion of the medulla within the brainstem. Wallenberg syndrome affects many anatomical structures, including the nucleus ambiguous, trigeminal nucleus, spinothalamic tract, cerebellum, and vestibular nuclei. Symptoms include sensory deficits to the contralateral trunk and extremities, ipsilateral face and cranial nerves with associated dysphagia, dysphonia and Horner syndrome. Rehabilitation and multidisciplinary care involving multiple specialties is imperative to improve functional outcomes in such patients.

Conclusion: This case highlights the many complications of Wallenberg syndrome and the subsequent need for a multidisciplinary rehabilitation treatment approach.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/getting-over-the-wall-of-wallenberg-a-case-report-about-a-multidisciplinary-rehab-approach/