Imbalance, Nystagmus and Diplopia in Wallenberg's Syndrome: Clinical analysis of a case and post-mortem examination

Abstract

Disequilibrium, nystagmus of various types, and diplopia are prominent features of Wallenberg's syndrome. In the case reported here the general condition of the patient was good and allowed an extensive series of examinations from the onset of the disorder. The study revealed several interesting features:

(1) 2-3 horizontal-rotatory nystagmus to the left occurred when the eyes were open.

(2) The direction of nystagmus was reversed (from left to right) on eye closure.

(3) After the first weeks caloric nystagmus could often be elicited only when the yes were open.

(4) During the third to fifth months the spontaneous nystagmus was largely replaced by irregular eye movements in all directions of gaze.

(5) Vertical divergence of the eye axes was present in all fields of gaze.

The patient died suddenly from heart failure 7 months after the onset. Autopsy showed a typical lateral infarction in the right side of the medulla.

The reversal of nystagmus and the disappearance of caloric response on eye closure are not explainable on the basis of commonly accepted principles.