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Uncommon Causes of the Lateral Medullary Syndrome: Report of a Case of Metastatic Carcinoma

Uncommon Causes of the Lateral Medullary Syndrome: Report of a Case of Metastatic Carcinoma Abstract The symptoms that constitute the lateral medullary syndrome are well established.1-3 The majority are due to infarction,4 but neoplasm,5-7 vascular malformation,8 radionecrosis,9 and abscess10 also can produce it. Those unusual cases are listed in the Table. I describe a patient in whom the syndrome was caused by metastatic oat cell carcinoma. REPORT OF A CASE A 41-year-old woman was asymptomatic for a year following lobectomy and radiation therapy for an oat cell carcinoma of the right upper lobe. She was then hospitalized for headache, nausea, ataxia, slurred speech, and progressive lethargy.Examination revealed severe dysphasia and dysarthria with absent left palatal elevation. She had a broad-based, slow, and markedly ataxic gait with a tendency to fall to the left. Mild papilledema existed. Pupils were equal and reacted normally. There was horizontal nystagmus on lateral gaze to the right. Ptosis of the left eye was References 1. Lewis GN, Littman A, Foley EF: Syndrome of thrombosis of posterior inferior cerebellar artery: Report of 28 cases . Ann Intern Med 36:592-602, 1952.Crossref 2. Peterman AF, Siedert RG: The lateral medullary (Wallenberg) syndrome: Clinical features and prognosis . Med Clin North Am 44:887-896, 1960. 3. Currier RD: Syndromes of the medulla oblongata , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . New York, American Elsevier Publishing Co Inc, 1969, vol 2, pp 217-237. 4. Fisher CM, Karnes WE, Kubik CS: Lateral medullary infarction: The pattern of vascular occlusion . J Neuropathol Exp Neurol 20:323-379, 1961.Crossref 5. Davison C, Spiegel LA: The syndrome of the posterior inferior cerebellar artery resulting from a metastatic neoplasm . J Neuropathol Exp Neurol 4:172-177, 1945.Crossref 6. McFarland HR, Truscott BL: A brain-stem lesion of unusual etiology: A case report . Neurology 11:597-600, 1961.Crossref 7. Ogawa M, Yamanouchi H, Togi H, et al: Autopsy case of Wallenberg's syndrome caused by metastasis of lung neoplasm to the medulla oblongata . Clin Neurol 17:25-30, 1977. 8. Barnett HJ, Hyland HH: Tumours involving the brain-stem: A study of 90 cases arising in the brain-stem, fourth ventricle, and pineal tissue . Q J Med 21:265-284, 1952. 9. Volk B, Busse O, Brusis T: Wallenberg syndrome bei Röntgen-Spätschädigung der Medulla Oblongata . Nervenarzt 51:373-377, 1972. 10. Quast M, Liebegott G: Zur Pathogenese des Wallenberg-Syndroms . Beitr Pathol 154:308-323, 1975.Crossref 11. Bernat JL, Hunter RW: The benign lateral medullary syndrome . Arch Neurol 35:112-113, 1978.Crossref 12. Hunter KMF, Rewcastle NB: Metastatic neoplasms of the brain-stem . Can Med Assoc J 98:1-7, 1968. 13. Derby BM, Guiang RL: Spectrum of symptomatic brain-stem metastasis . J Neurol Neurosurg Psychiatry 38:888-895, 1975.Crossref 14. Weiss HD, Richardson EP Jr: Solitary brain-stem metastasis . Neurology 28:562-566, 1978.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Uncommon Causes of the Lateral Medullary Syndrome: Report of a Case of Metastatic Carcinoma

Archives of Neurology , Volume 37 (10) – Oct 1, 1980

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Publisher
American Medical Association
Copyright
Copyright © 1980 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1980.00500590093018
Publisher site
See Article on Publisher Site

Abstract

Abstract The symptoms that constitute the lateral medullary syndrome are well established.1-3 The majority are due to infarction,4 but neoplasm,5-7 vascular malformation,8 radionecrosis,9 and abscess10 also can produce it. Those unusual cases are listed in the Table. I describe a patient in whom the syndrome was caused by metastatic oat cell carcinoma. REPORT OF A CASE A 41-year-old woman was asymptomatic for a year following lobectomy and radiation therapy for an oat cell carcinoma of the right upper lobe. She was then hospitalized for headache, nausea, ataxia, slurred speech, and progressive lethargy.Examination revealed severe dysphasia and dysarthria with absent left palatal elevation. She had a broad-based, slow, and markedly ataxic gait with a tendency to fall to the left. Mild papilledema existed. Pupils were equal and reacted normally. There was horizontal nystagmus on lateral gaze to the right. Ptosis of the left eye was References 1. Lewis GN, Littman A, Foley EF: Syndrome of thrombosis of posterior inferior cerebellar artery: Report of 28 cases . Ann Intern Med 36:592-602, 1952.Crossref 2. Peterman AF, Siedert RG: The lateral medullary (Wallenberg) syndrome: Clinical features and prognosis . Med Clin North Am 44:887-896, 1960. 3. Currier RD: Syndromes of the medulla oblongata , in Vinken PJ, Bruyn GW (eds): Handbook of Clinical Neurology . New York, American Elsevier Publishing Co Inc, 1969, vol 2, pp 217-237. 4. Fisher CM, Karnes WE, Kubik CS: Lateral medullary infarction: The pattern of vascular occlusion . J Neuropathol Exp Neurol 20:323-379, 1961.Crossref 5. Davison C, Spiegel LA: The syndrome of the posterior inferior cerebellar artery resulting from a metastatic neoplasm . J Neuropathol Exp Neurol 4:172-177, 1945.Crossref 6. McFarland HR, Truscott BL: A brain-stem lesion of unusual etiology: A case report . Neurology 11:597-600, 1961.Crossref 7. Ogawa M, Yamanouchi H, Togi H, et al: Autopsy case of Wallenberg's syndrome caused by metastasis of lung neoplasm to the medulla oblongata . Clin Neurol 17:25-30, 1977. 8. Barnett HJ, Hyland HH: Tumours involving the brain-stem: A study of 90 cases arising in the brain-stem, fourth ventricle, and pineal tissue . Q J Med 21:265-284, 1952. 9. Volk B, Busse O, Brusis T: Wallenberg syndrome bei Röntgen-Spätschädigung der Medulla Oblongata . Nervenarzt 51:373-377, 1972. 10. Quast M, Liebegott G: Zur Pathogenese des Wallenberg-Syndroms . Beitr Pathol 154:308-323, 1975.Crossref 11. Bernat JL, Hunter RW: The benign lateral medullary syndrome . Arch Neurol 35:112-113, 1978.Crossref 12. Hunter KMF, Rewcastle NB: Metastatic neoplasms of the brain-stem . Can Med Assoc J 98:1-7, 1968. 13. Derby BM, Guiang RL: Spectrum of symptomatic brain-stem metastasis . J Neurol Neurosurg Psychiatry 38:888-895, 1975.Crossref 14. Weiss HD, Richardson EP Jr: Solitary brain-stem metastasis . Neurology 28:562-566, 1978.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Oct 1, 1980

References