Traumatic vertebral artery dissection and Wallenberg syndrome after a motorcycle collision

• Published in: The American journal of emergency medicine 2009, Vol.27 (1), p.131.e1-131.e3
• Main Authors: Yeh, Hsiu-Fen, MD, Seak, Chen-June, MD, Chiu, Te-Fa, MD, Chang, Yu-Che, MD
• Format: Article
• Language: English
• Subjects: Accidents, Traffic; Adult; Anticoagulants; Emergency; Emergency medical care; Humans; Lateral Medullary Syndrome - etiology; Magnetic resonance imaging; Male; Medical imaging; Motorcycles; Risk factors; Spinal manipulation; Veins & arteries; Vertebral Artery Dissection - complications
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2008.04.025

Wallenberg syndrome is also called lateral medullary syndrome or posterior inferior cerebellar artery syndrome. The clinical presentations include ipsilateral Horner syndrome, ipsilateral cerebellar signs, and the hypalgesia of ipsilateral face and contralateral body. A considerable number of cases of Wallenberg syndrome were reported to be associated with vertebral artery dissection (VAD). Nowadays, the preferred imaging tool comes down to magnetic resonance imaging because it provides high spatial resolution, which is especially important for assessment of lesions in posterior fossa. The optimal treatment of VAD remains controversial. Most patients receive conservative treatments with anticoagulants or antiplatelet drugs. Overall, most cases have good prognosis. However, the rarity and various presentations of VAD may challenge emergency physicians in making correct diagnosis in the emergency department. Hence, maintaining a high index of suspicion is needed for an early diagnosis, especially in young people without risk factors attributing to cerebrovascular accident.