Sudden Onset Wallenberg Syndrome Caused by Acute Demyelination and Leading to New MS Diagnosis
I am really curious to know if anyone else here in the MS community arrived at their diagnosis after a sudden episode of Wallenberg Syndrome.
I was drinking my morning coffee when the left side of my face suddenly went numb. A few minutes later I was choking and gagging on food and drink. It would all get stuck in my throat and I couldn’t swallow. 24 hours of this and my primary was mystified by the symptoms—she ordered me to the ER to rule out a TIA.
Surprise, surprise, the initial work up was totally unremarkable with a clean CT and labs. The ER doctor got close when he was thinking Horner’s Syndrome, but I didn’t have all the signs for it. He consulted with neurovascular and they had me transferred to the main ED for an MRI. I was still walking and neurologically intact at this point.
48 hours after onset the vertigo hit with intense waves of nausea and vomiting. A third set of neurologists came to reevaluate me (teaching hospital) and that attending spotted the changes on the MRI.
The attending saw an actively demyelinating lesion on the left, lateral side of the medulla and inflammation to the adjacent cranial nerves. They immediately admitted me and ordered additional MRIs of spine and lumbar puncture.
60 some hours after onset, I could not walk without assistance. 72 hours after onset my left leg had deficits and I could not even stand without falling left. My distal reflexes were uneven and very brisk on the left side. Hoffman‘s signs were present on both hands.
The interesting part is that with my Wallenberg Syndrome, my body deficits were ipsilateral to the lesion and not contralateral, which is the typical finding.
It took about 3 days for my CSF studies to start populating and as you may have predicted by now—I had a ”high” number of OGC bands.
I had the standard 5 days of high dose Solu-Medrol and a rituximab infusion. I am now 10 weeks out from that demyelination and still really feeling it, especially with walking and decreased sensation.
Has anyone else here experienced this? Most of the medical literature attributes Wallenberg to a stroke, but mine was from MS. Just curious…