Wallenberg Syndrome: An Exceptional Cause of Acute Vertigo in Children

Abstract

The assessment of acute vertigo in childhood is often challenging, but fortunately a central cause is rarely identified. We present the case of a 7-year-old boy who developed, after a mild head trauma, a rotary vertigo associated with nausea and vomiting. A posttraumatic peripheral vestibular dysfunction was first suspected but not confirmed by an otoneurological evaluation. When subtle neurological signs were elicited, a brain magnetic resonance imaging was promptly requested. This showed a small infarct on the lateral posterior left part of the medulla oblongata of the brainstem, typical of Wallenberg syndrome. Vascular imaging was normal and no defined etiology was found. The child was started on prophylactic acetylsalicylic acid. The rapid disappearance of vertigo was noted. On follow-up at 6 months, there has been no recurrence and neurological examination was fully normal. Our case extends the differential diagnosis of acute vertigo in childhood that rarely includes the possibility of a brainstem infarct whose recognition through appropriate clinical examination is nevertheless capital for appropriate investigations and management.

Keywords

Wallenberg syndrome - acute rotatory vertigo - posterior circulation stroke in childhood

• References

• 1 Jahn K, Langhagen T, Heinen F. Vertigo and dizziness in children. Curr Opin Neurol 2015; 28 (1) 78-82
• 2 Kattah JC, Talkad AV, Wang DZ, Hsieh YH, Newman-Toker DE. HINTS to diagnose stroke in the acute vestibular syndrome: three-step bedside oculomotor examination more sensitive than early MRI diffusion-weighted imaging. Stroke 2009; 40 (11) 3504-3510
• 3 Day GS, Swartz RH, Chenkin J, Shamji AI, Frost DW. Lateral medullary syndrome: a diagnostic approach illustrated through case presentation and literature review. CJEM 2014; 16 (2) 164-170
• 4 Rollins N, Pride GL, Plumb PA, Dowling MM. Brainstem strokes in children: an 11-year series from a tertiary pediatric center. Pediatr Neurol 2013; 49 (6) 458-464
• 5 Ganesan V, Chong WK, Cox TC, Chawda SJ, Prengler M, Kirkham FJ. Posterior circulation stroke in childhood: risk factors and recurrence. Neurology 2002; 59 (10) 1552-1556
• 6 Mackay MT, Prabhu SP, Coleman L. Childhood posterior circulation arterial ischemic stroke. Stroke 2010; 41 (10) 2201-2209
• 7 Kovacs SO, Kuban K, Strand R. Lateral medullary syndrome following varicella infection. Am J Dis Child 1993; 147 (8) 823-825
• 8 Kibe T, Ikeya M, Yokochi K, Okumura N. Lateral medullary syndrome in a boy with hereditary dysfibrinogenemia. Brain Dev 2012; 34 (10) 857-860
• 9 Ng J, Connolly DJ, Rittey CD, Mordekar SR. Skull base osteomyelitis leading to lateral medullary syndrome in a child. Eur J Paediatr Neurol 2007; 11 (2) 111-114
• 10 Riechwien R, Unger G. Study of a case of Wallenberg's syndrome in childhood in addition to observations on cerebral vascular processes in children [in German]. Monatsschr Kinderheilkd 1966; 8: 442-443
• 11 Serrano ML, Garí M, Castro P, Garzo C, Maroto C, Maroto E. Wallenberg syndrome in childhood secondary to the striking by lightening [in Spanish]. Rev Neurol 1995; 23 (120) 414-416
• 12 Toelle SP, Albisetti M, Holzmann D, Steinlin M. A 9-year-old girl who swung on a rope. Lancet 1997; 350 (9090) 1516
• 13 Simonnet H, Deiva K, Bellesme C , et al. Extracranial vertebral artery dissection in children: natural history and management. Neuroradiology 2015; 57 (7) 729-738
• 14 Hasan I, Wapnick S, Tenner MS, Couldwell W. Vertebral artery dissection in children: a comprehensive review. Pediatr Neurosurg 2002; 37 (4) 168-177
• 15 Tarnutzer AA, Berkowitz AL, Robinson KA, Hsieh YH, Newman-Toker DE. Does my dizzy patient have a stroke? A systematic review of bedside diagnosis in acute vestibular syndrome. CMAJ 2011; 183 (9) E571-E592