User:Rolfsmmj/sandbox

We have additional material to add to the history, treatment, diagnosis, and symptoms sections. We will edit them if needed. The links that were used in each paragraph are listed directly below the paragraph. They are just pasted as the link and will be formatted later

Peer review: Really good, thorough information added. I suggest adding more information to the epidemiology section since there is not one; data on incidence or prevalence of Lateral Medullary Syndrome within a population. Also, are there any morbidity or mortality rates associated with this syndrome that you could find? It would be interesting to know about frequency, or how often a stroke occurs and Lateral Medullary Syndrome was a resulting outcome vs. a stoke and no resulting syndrome (if that information is available). Otherwise I think this looks like a great start, good references.

For the Diagnosis section, we will be deleting the current content of the diagnosis section and combining it with the symptoms section and adding this to create a new diagnosis section: “Since lateral medullary syndrome is often caused by a stroke, diagnosis is time dependent. Diagnosis is usually done by assessing vestibular-related symptoms in order to determine where in the medulla that the infarction has occurred. Head Impulsive Nystagmus Test of Skew (HINTS) examination of oculomotor function is often performed, along with computed tomography (CT) or magnetic resonance imaging (MRI) to assist in stroke detection. Standard stroke assessment must be done to rule out a concussion or other head trauma.” From http://www.sciencedirect.com.proxy.uwec.edu/science/article/pii/S0735675716301310  and https://www.physio-pedia.com/Wallenberg_Syndrome

Will added to existing treatment section: “Often times a blood thinner is prescribed to the patient in order to break up the infarction and reestablish blood flow and to prevent future infarctions.  " From http://www.sciencedirect.com.proxy.uwec.edu/science/article/pii/S0735675716301310 “For dysphagia symptoms, Repetitive transcranial magnetic stimulation has been shown to assist in rehabilitation.  Overall, traditional stroke assessment and outcomes are used to treat patients, since lateral medullary syndrome is often a cause of a stroke in the lateral medulla” From https://www.physio-pedia.com/Wallenberg_Syndrome

We redid the entire symptoms section and combined it with what was the diagnosis section, since that had nothing to do with diagnosis:

“This syndrome is characterized by sensory deficits that affect the trunk and extremities contralaterally, and sensory deficits of the face and cranial nerves isolaterally. Specifically a loss of pain and temperature sensation if the spinothalamic tract is impacted. The cross body finding is the chief symptom from which a diagnosis can be made. Patients often have difficulty walking or maintaining balance, or difference in temperature of an object based on which side of the body it is touching. Some patients may walk with a slant or suffer form skew deviation and illusions of room tilt. The nystagmus is commonly associated with vertigo spells. These can result in falling, caused from the involvement of the region of Deiters’ nucleus.   Common symptoms with lateral medullary syndrome include difficulty swallowing, or dysphagia. This is caused by the involvement of the nucleus ambiguous, as it supplies the vagus and glossopharyngeal nerves. Slurred speech (dysarthria), and disordered vocal quality (dysphonia) are also common.   The damage to the cerebellum or the inferior cerebellar peduncle can cause ataxia. Damage to the hypothalamospinal fibers disrupts sympathetic nervous system relay and gives symptoms analogous to Horner syndrome.   Palatal myoclonus may be observed due to disruption of the central tegmental tract.   Other symptoms include: hoarseness, nausea, vomiting, hiccups, a decrease in sweating, problems with body temperature sensation, dizziness, difficulty walking, and difficulty maintaining balance.   The syndrome can also cause bradycardia, or a slow heart rate, and low or high blood pressure.[2]” From existing material and https://www.physio-pedia.com/Wallenberg_Syndrome and http://www.strokecenter.org/professionals/stroke-diagnosis/stroke-syndromes/lateral-medullary-syndrome-wallenberg-syndrome/

To be added at the end of the prognosis section: “More than 85% of patients have seen minimal symptoms at six months from the time of stroke, and have been independent within a year. “ From https://www.physio-pedia.com/Wallenberg_Syndrome

We will make a new epidemiology section: “Those at the overall highest risk for lateral medullary syndrome are men at an average age of 55.06. Having a history of hypertension, diabetes and smoking all increase the risk of large artery atherosclerosis, which is thought to be the greatest risk factor for lateral medullary syndrome.” From https://www.physio-pedia.com/Wallenberg_Syndrome The history section is lacking in material and will be deleted, so this will be added: “The earliest description of Lateral Medullary Syndrome was first written by Gaspard Vieusseux at the Medical and Chirurgical Society of London describing the symptoms observed at the time. Adolf Wallenberg further reinforced these signs after completing his first case report in 1895. He was able to make an accurate localization of the lesion and soon after proved it following a postmortem examination. Wallenberg accomplished three more published articles about Lateral Medullary Syndrome.

Adolf Wallenberg

Adolf Wallenberg was a renowned neurologist and neuroanatomist most widely known for his clinical descriptions of Lateral Medullary Syndrome. He completed his doctorate at University of Leipzig in 1886. By 1928 he had spent 2 years (1886-1888) as an assistant at the city hospital in Danzig, 21 years (1907-1928) as the director of internal and psychiatric departments and 18 years (1910-1928) as a titular professor. In 1929, Wallenberg received the Erb Commemorative Medal for his work in the field of anatomy, physiology and pathology of the nervous system.

Wallenberg's first patient in 1985 was a 38 year old male suffering from symptoms of vertigo, hypoesthesia, loss of pain and temperature sensitivity, paralysis of multiple locations, ataxia and more. His background in neuroanatomy helped him in correctly locating the patient's lesion to the lateral medulla and connected it to a blockage of the ipsilateral posterior inferior cerebral artery. After the death of his patient in 1899, he was able to prove his findings after a postmortem examination. He continued his work with many patients and by 1922 he had reported his 15th patient with clinicopathological correlations. In 1938, Adolf Wallenberg was forced to end his career as a physician by the German occupation.”

Fromhttps://books.google.com/books?id=hfjSVIWViRUC&pg=RA3-PA744&dq=adolf+wallenberg&hl=en&sa=X&ved=0ahUKEwiF45DAsbDXAhUG32MKHQHyBNAQ6AEILTAB#v=onepage&q=adolf%20wallenberg&f=false and http://jnnp.bmj.com/content/68/5/570 Rolfsmmj (talk) 21:20, 12 November 2017 (UTC) Rolfsmmj (talk) 00:41, 11 November 2017 (UTC)