Dados do Trabalho

Título

FIRST CASE OF OCULAR CONTRAPULSION FOLLOWED BY IPSIPULSION IN WALLENBERG SYNDROME

RESUMO

Case Report
A 51-year-old man presented with a sudden rotatory dizziness, unsteady gait, and numbness in the left hemibody. He showed left palate paresis, incoordenation, horizontal jerk nystagmus with left fast fase, and ocular contrapulsion evoked by eye closure. Magnetic Resonance Imagingresonance imaging (MRI) Flairflair showed left cerebellar hyperintensity. Diffusion-Weighted Imaging (DWI)/Apparent Diffusion Coefficient (ADC) showed infarction in the left lateral medulla. After 7 days of symptoms, he reported intermittent hiccups treated with chlorpromazine. The ocular exam at this time revealed ocular lateropulsion ipsilateral to the lesion (ipsipulsion)
Discussion
Wallenberg syndrome, also called lateral medullar syndrome, is caused by the infarct in the territory of posterior inferior cerebellar artery. Its clinical signs and symptoms include vertigo, nystagmus, diplopia, ipsilateral Horner syndrome, facial ruddiness and dry skin, dysphonia, dysphagia, dysarthria, ipsilateral loss of gag reflex, ipsilateral ataxia, ipsilateral impaired taste, ipsilateral facial pain and paresthesia, decreased ipsilateral blink reflex, contralateral hypoalgesia and thermoanaesthesia in the trunk and limbs; and ipsilateral facial hypoalgesia and thermoanaesthesia.
Conclusion
To our knowledge, this semiologic feature of alternating lateropulsion has not been previously described in the literature until now. The scientific study of atypical clinical manifestations can help medical care to identify the syndrome early and to better manage patients.

Palavras Chave

Wallenberg Syndrome; Ocular Contrapulsion