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.

Characteristics of Acute Nystagmus in the Pediatric Emergency Department

“…In fact, vertebrobasilar infarcts are a rare cause of stroke in children, their frequency ranging from 6% to 13% of all pediatric strokes, [14][15][16][17][18] and nystagmus is rarely cited among the presenting signs. 17 These findings suggest that posterior circulation infarcts are an exceptional cause of acute vestibular syndrome in children, 19 whereas posterior fossa tumors are more frequently associated.…”

Pediatric stroke related to Lyme neuroborreliosis: Data from the Swiss NeuroPaediatric Stroke Registry and literature review

“…[15,17] We wish to highlight the unusual occurrence of Wallenberg syndrome, in 3 out the 12 documented cases (including 2out of the SNPSR), which is only rarely reported in the pediatric literature. [24] This predilection for posterior circulation stroke differs significantly from the vast majority of cases of focal cerebral arteriopathy in childhood, including the post-varicella angiopathy, that exhibit a strong predilection to the anterior circulation, and more precisely to the M1 segment of the middle cerebral artery. [25] This posterior predilection is probably explained by a predominant basal leptomeningeal obliterative inflammatory vasculopathy (endarteritis), which has been reported in pathological studies and in experimental research.…”

Neuro-otology symptoms as the early sign in pediatric patient with a pineal gland tumor: a case report

“…Functional dizziness, sensory disturbances–bilateral peripheral vestibular loss, and central vertigo can be recognized as persistent complaints and have specific clinical characteristics [9] . Central vertigo rarely occurs in children, but this diagnosis should not be disregarded since it is related to the prognosis of underlying diseases such as tumors [10] . Tumors of the pineal region of children can affect sleep patterns.…”