Wallenberg's Syndrome with Diplopia : Report of a Case

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  • KOIKE Hidemi
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • TAKANASHI Tomoko
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • IRIE Hiroshi
    The First Department of Internal Medicine, Kyorin University School of Medicine
  • YOSHINO Yoshikazu
    The First Department of Internal Medicine, Kyorin University School of Medicine

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  • 複視をきたしたWallenberg症候群の1例

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We report a case of Wallenberg's syndrome with vertical diplopia. A 36-year-old man with polycythemia was admitted to our hospital because of vertigo and diplopia. Neurologically, horizonto-rotary nystagmus to the left, disturbed temperature and pin-prick sensations of the right face and the left side of the body, Iaterbpulsion of the body to the right, dysphagia, right Horner's syndrome, and vertical diplopia during downward gaze were present. The vertical diplopia was relieved by tilting head to the right. Hess chart examined 7 days after the onset revealed left superior oblique muscle palsy, suggesting dysfunction of the right trochlear nucleus. T2 weighted MR images demonstrated localized high intensity area in the right dorsolateral medulla. No additional lesions were detected in other areas including right trochlear nucleus region. The vertical diplopia was considered to be due to dysfunction of the right trochlear nucleus and probably left oculomotor nucleus innervating inferior rectus muscle caused by the damage to the right vestibular nucleus, restiform body and medullary reticular nuclei, or by the interruption of the connection among these nuclei. Vertical diplopia relieved by tilting head to the side of the lesion is a rare phenomenon in patients with Wallenberg's syndrome.

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