312 - Rare Case of Wallenberg Syndrome Secondary to Type B Aortic Dissection: A Case Report

Lateral medullary (Wallenberg) syndrome secondary to Type B aortic dissection (DeBakey IIIb) with incidental right MCA infarct.

Case Description:

A 49-year-old male with hypertension, hyperlipidemia, and poorly controlled type 2 diabetes presented with three days of dizziness, gait instability, right-eye blurry vision, and left-sided numbness. CTA chest revealed a DeBakey IIIb aortic dissection extending from the distal thoracic aorta to the left iliac arteries. Neurologic exam showed persistent hiccups, diplopia, nystagmus, ipsilateral limb dysmetria, truncal ataxia, impaired contralateral pain and temperature sensation, and gait imbalance, classic for lateral medullary (Wallenberg) syndrome. MRI confirmed the diagnosis of lateral Wallenberg syndrome as well as an incidental infarct in the MCA. He was admitted to the SICU for strict BP control and multidisciplinary care. On rehabilitation admission, the patient required assistance for transfers, ambulation, and ADLs. PT targeted gait, balance, and endurance. OT addressed ADLs and fine motor coordination.

 

Discussions:

Lateral medullary syndrome (Wallenberg) from vertebral artery compromise due to aortic dissection is exceptionally rare, especially with concurrent incidental MCA infarct. This combination created overlapping anterior and posterior circulation deficits, producing severe ataxia, dysmetria, visual-vestibular disturbance, and intractable hiccups. These symptoms limited therapy intensity and endurance. Rehabilitation required constant coordination with the medical team to balance neurological recovery goals with strict hemodynamic control to prevent dissection extension.

Conclusions:

This case underscores the adaptability of rehabilitation medicine in treating complex neurological deficits from brainstem stroke in the context of high-risk cardiovascular disease, emphasizing interdisciplinary coordination to maximize safe, meaningful recovery.