Objective: This case study describes the neuropsychological consequences of a 31 year old, Caucasian, right-handed female who sustained a left vertebral artery dissection with left medullary infarct and associated Wallenberg syndrome in May, 2014. Method: Wallenberg syndrome is a rare neurological syndrome associated with infarct of the medulla. While the etiology of this syndrome is not always identified, a cerebral MRI/MRA confirmed a left vertebral artery dissection resulting in a left medullary infarct. The constellation of symptoms coincided with Wallenberg syndrome and included dizziness, diplopia, nausea, vertigo, dysphagia, vocal cord paralysis, and hiccups. Furthermore, she presented with left hemiparesis and ataxia. She required acute hospitalization, a period of subacute rehabilitation, and intensive inpatient brain injury rehabilitation. The persistent nature of her symptoms precluded her from returning to gainful employment as a first grade teacher. At 5 months post infarct, she was referred for comprehensive neuropsychological consultation. Results: MM's neuropsychological test results (10/20/14) suggested ongoing, albeit mild cognitive impairments despite normal scores on standardized neuropsychological indices (Halstead Impairment Index 0.3, GNDS 21). Primary deficits were in areas of sustained levels of attention/concentration, information processing speed, tactual localization memory, and nondominant LUE sensorimotor abilities. Adjustment difficulties, including reactive depression, anxiety, and somatic preoccupation, contributed to the clinical picture. Conclusion: This case study underscores the importance of establishing a baseline of neuropsychological functions in individuals with medullary infarct with associated Wallenberg syndrome to assist in developing appropriate treatment recommendations with emphasis toward vocational reintegration.
NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: CEREBROVASCULAR DISEASE
Left Vertebral Artery Dissection with Left Medullary Infarct and Associated Wallenberg Syndrome: A Clinical Case Study
M Raymond, D Louis; NEUROLOGICAL AND NEUROPSYCHIATRIC DISORDERS: CEREBROVASCULAR DISEASE
Left Vertebral Artery Dissection with Left Medullary Infarct and Associated Wallenberg Syndrome: A Clinical Case Study. Arch Clin Neuropsychol 2015; 30 (6): 487. doi: 10.1093/arclin/acv047.03
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