Behind the Dizziness: A Clinical Journey to Wallenberg Syndrome

Wallenberg syndrome, also referred to as lateral medullary syndrome or posterior inferior cerebellar artery (PICA) syndrome, is a rare neurological disorder most often caused by occlusion of the PICA. It leads to infarction of the lateral medulla oblongata and presents with a range of symptoms, including vertigo, ataxia, cranial nerve deficits, and sensory disturbances. We present the case of a 41-year-old female who initially attended the emergency department (ED) with headache, nausea, and vomiting. She was treated for a urinary tract infection (UTI) with associated urinary retention. However, shortly after being discharged, she collapsed within the hospital grounds. Her medical history included hypertension and type 2 diabetes mellitus (T2DM). A computed tomography (CT) head scan showed no acute findings, but a subsequent magnetic resonance imaging (MRI) confirmed an acute left lateral medullary infarct, establishing the diagnosis of Wallenberg syndrome. This atypical presentation, which caused the misdiagnosis, can have a serious effect on the treatment of a stroke and the important decision to thrombolyse or not. This delay in treatment could cause long-term damage to the patient by affecting their day-to-day life.