{
  "abstract": "Background Wallenberg syndrome was given a detailed description in 1895 by Adolf Wallenberg, who identified this condition as infarction of the lateral medulla oblongata. 1 Large artery atherothrombotic causes represent 75% of cases, with cardioembolic and vertebral artery dissection being other common causes.2 3 Clinical Presentation 55M with hypertension, Type 2 DM and hypercholesterolaemia presented as a code stroke to the ED after waking up at 3 am to use the bathroom and developing vertigo. He also experienced left eye conjunctival pallor. He had an ataxic gait. He had normal imaging at code stroke which did not show any acute bleed, nil large vessel occlusion and nil perfusion abnormalities. At this point, patient’s only concerning feature was ataxia and lethargy with a mild headache.He had a positive head impulse test. He was discharged after clearance from physiotherapy with antiemetics and low dose prednisolone.Two days later, patient represented with worsening left sided gait unsteadiness. He had developed worsening left sided facial numbness. He also described right arm reduced sensation to hot water.MRI Brain then revealed acute ischaemia related diffusion restriction in the lateral part of medulla oblongata, measuring 9mm x 6mm x 8mm. Nil evidence of arterial dissection.Conclusion Wallenbergs syndrome has myriad presentations. Despite lacking definite clinical signs consistent with central vertigo, the aforementioned patient had a large lateral medullary infarction and it was discovered only on repeat presentation, confirmed only on MRI, an imaging investigation not rapidly available as an inpatient.References Lui F, Tadi P, Anilkumar AC. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 25, 2023. Wallenberg Syndrome.Inamasu J, Nakae S, Kato Y, Hirose Y. Clinical characteristics of cerebellar infarction due to arterial dissection. Asian J Neurosurg. 2018 Oct-Dec;13(4):995–1000.Saleem F, Das JM. StatPearls StatPearls Publishing; Treasure Island (FL): Aug 7, 2023. Lateral Medullary Syndrome.",
  "authors": [
    {
      "affiliations": [
        "Neurology, Gold Coast University Hospital, Gold Coast, QLD, Australia"
      ],
      "name": "Vinod Rajasingam"
    },
    {
      "affiliations": [
        "Neurology, Gold Coast University Hospital, Gold Coast, QLD, Australia"
      ],
      "name": "Peter Bailey"
    }
  ],
  "title": "3560 Wallenbergs syndrome presenting initially as recurrent peripheral type vertigo to emergency department",
  "uid": "24ad4e89-482c-53e1-bae9-73ddec2f570c"
}