What is Wallenberg Syndrome

Abstract

The Wallenberg syndrome consists of a variety of neurological symptoms that Adolf Wallenberg described in great detail as early as 1895 and attributed to a comparatively tiny lesion in the dorsolateral medulla oblongata. Dysphagia is a symptom that has received little attention in recent literature, but is clinically very relevant. There are hardly any systematic studies available, both with regard to the type of disorder and with regard to the intervention options. The aim of the present prospective study was to find out on the one hand which phase and functions of the swallowing process are impaired in Wallenberg syndrome or whether there is a typical disorder pattern and on the other hand to evaluate the effectiveness of specific swallowing therapy. 28 patients were examined who suffered from neurogenic dysphagia, had Wallenberg syndrome clinically and who had a unilateral lesion of the dorsolateral medulla oblongata on magnetic resonance imaging. It was found that there was primarily a disorder of the pharyngeal swallowing phase, which manifested itself in particular in a disturbed swallowing reflex triggering and in an opening disorder of the upper esophageal sphincter. Regarding the question of the effectiveness of a specific swallowing therapy, it could be shown that the risk of aspiration decreased significantly with targeted, individually adapted inpatient swallowing therapy. A significant improvement in the main target variable "diet", defined by an ordinal scale with 7 degrees of severity from 0 (fully orally fed) to 6 (complete nutrition via PEG or nasogastric tube) could be achieved. Clinically, this means that after swallowing therapy, 21 patients (75.0%) could be fed fully orally, compared to one patient (3.6%) before therapy. In summary, the results indicate that in Wallenberg syndrome in particular the triggering of the swallowing reflex and the opening of the upper esophageal sphincter are disturbed. With targeted and qualified swallowing therapy, the prognosis of dysphagia in patients with Wallenberg syndrome can, however, be described as good, even if the disorder is initially severe or has existed for a long time.