Brainstem Strokes and Wallenberg Syndrome: What Should Med SLPsKnow?

VIDEO RESOURCE:
I’ve got a free gift for you over at medslpcollective.com. You’ll get instant access to our free MedSLP Collective clipboard kit, which includes our Clinical Swallow Examination Resource.
ACCESS TO MED SLP RESOURCES:
Get my Amazon and Barnes & Noble Best Selling Book;
So You're Having Trouble Swallowing: The essential guide to basic swallowing, swallowing disorders, and navigating care.
📒 theresarichard...
Listen to the Swallow Your Pride Podcast:
Dive deeper into the issues that speech-language pathologists face when working with patients with swallowing disorders.
🎧 swallowyourpri...
MedSLPEd (an approved ASHA CEU provider):
Offering live and recorded online courses that fill the gap between grad school and clinical practice. Each course is in-depth, goes far beyond the textbook rhetoric, and focuses on case-based learning.
🖥️ medslped.com/
MedSLP Clipboard Kit:
30 blind editorial reviewed resources written by 15 contributors with over 150 references to support its contents.
📋 medslpcollecti...
MedSLP Pediatric Clipboard Kit:
Get instant access to blind editorial-reviewed pediatric resources for Medical SLPs with references to support its contents.
📋 info.medslpcol...
CITED ARTICLES:
Basinger, H., & Hogg, J. P. (2020). Neuroanatomy, Brainstem. PubMed; StatPearls Publishing. www.ncbi.nlm.n...
Jean, A. (2001). Brain Stem Control of Swallowing: Neuronal Network and Cellular Mechanisms. Physiological Reviews, 81(2), 929-969. doi.org/10.115...
Maharay, K. (2021, July 12). A Quick-Start Guide to Lateral Medullary Stroke. The Medical SLP Collective. medslpcollecti...
Purnell, F. (2022, July 11). Shared Anatomy, Functions, and Neural Substrates of Swallow and Cough - Part 1. The Medical SLP Collective. medslpcollecti...
McCoy, Y. (2018, Dec. 12). Neural Control of Swallowing. The Medical SLP Collective. medslpcollecti...
Yuichiro Yoneoka, Ryo Ikeda, Naotaka Aizawa, Yasuhiro Seki, Katsuhiko Akiyama. Medial pontomedullary junctional infarction presenting vertigo, ipsilateral facial paresis, contralateral thermal hypoalgesia and dysphagia without lateral gaze palsy, curtain sign and hoarseness: a case presentation of a novel brain stem stroke syndrome with sensory disturbance-based dysphagia and review of the literature. Oxford Medical Case Reports. Volume 2019, Issue 1. January 2019. doi.org/10.109...
Chalela, J., Kidwell, C., Nentwich., L., et. al. (2007). Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. The Lancet, 369 (9558). doi.org/10.101...
Day, G., Swartz, R., Chenkin, J., Shamji, A., & Frost, D. (2014). Lateral medullary syndrome: A diagnostic approach illustrated through case presentation and literature review. Canadian Journal of Emergency Medicine, 16(2), 164-170. doi:10.2310/8000.2013.131059
Fu X, Lu Z, Wang Y, Huang L, Wang X, Zhang H, Xiao Z. A Clinical Research Study of Cognitive Dysfunction and Affective Impairment after Isolated Brainstem Stroke. Front Aging Neurosci. 2017 Dec 19;9:400. doi: 10.3389/fnagi.2017.00400. PMID: 29311895; PMCID: PMC5742202.
Jang, S.H., Kim, M.S. Dysphagia in Lateral Medullary Syndrome: A Narrative Review. Dysphagia 36, 329-338 (2021). doi.org/10.100...
Jang, S.H., Kwak, S.Y., Chang, C.H. et al. Prognostic Prediction of Dysphagia by Analyzing the Corticobulbar Tract in the Early Stage of Intracerebral Hemorrhage. Dysphagia 35, 985-992 (2020). doi.org/10.100...
Jong S. Kim, Pure lateral medullary infarction: clinical-radiological correlation of 130 acute, consecutive patients, Brain, Volume 126, Issue 8, August 2003, Pages 1864-1872, doi.org/10.109...
Maharay, K. (2021, July 12). A Quick-Start Guide to Lateral Medullary Stroke. The Medical SLP Collective. medslpcollecti...
Saleem F, Das J. Lateral Medullary Syndrome. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.n...
Kim H, Chung C, Lee K, Robbins J. Aspiration Subsequent to a Pure Medullary Infarction: Lesion Sites, Clinical Variables, and Outcome. Arch Neurol. 2000;57(4):478-483. doi:10.1001/archneur.57.4.478

[@AggressiveEnnui]

I found this to be exceedingly informative--thank you. The reason I tuned in is that I suspect I may have recently had either an infarct or hemorrhagic event based on a cluster of symptoms that showed up at around the same time last year (end of 2023) and that would correspond to a lesion in lateral medulla. I don't have dysphagia, but I do suffer central sleep apneas, blood pressure that became precariously elevated all of a sudden (210+/120+) left side facial numbness, hyperhidrosis (both sleep and gustatory) and several other oddities that all cropped up after I had what I thought was a severe migraine.
I'd suffered these headaches for 12 years, but this last one also featured trigeminal pain, dizziness (I fell), vomiting, and a very weird olfactory aura. I am putting all the pieces together for my primary care physician and perhaps he will refer me to a neurologist, or he may just tell me not to worry and ignore me... not sure. Nevertheless, perhaps the weirdest part is that I had had these headaches more or less biweekly for over a decade, and this big one was the last. Nothing for 9 months. Glad, but very strange...
I am a scientist with my PhD in neuroscience, which helps with familiarity for terminology, but I am most certainly not a clinician, which can be frustrating :). I am just hoping to learn whether I ought to be put on a blood-thinning protocol etc. because I would really hate for a follow up that was more severe... Anyway, thank you for this and similar. You're a talented lecturer. I appreciate all the hard work you've put in.

[@lexijolie]

This was incredibly resourceful! Thank you!

[@TheresaRichardMedicalSLP]

You're very welcome!

[@jillwhite790]

Excellent information. Would NMES be appropriate for this population?