Wallenberg Syndrome Following Anabolic-Androgenic Steroid Use: A Case Report

Background: Wallenberg syndrome is a rare ischemic stroke syndrome resulting from infarction in the posterior inferior cerebellar artery (PICA) territory. Anabolic-androgenic steroids (AAS), used frequently in athletic settings, are associated with prothrombotic and vasospastic phenomena that may increase the risk of cerebrovascular events. Case presentation: We report a case of a 39-year-old male strength coach with no prior medical history, who presented with acute onset of vomiting, singultus, ataxia, and ipsilateral facial hypoesthesia. He had a history of self-administered AAS cycles since the age of 19. MRI revealed a left cerebellar hemisphere infarct, and CT angiography hypoplasia of the left vertebral artery with occlusion of distal segments V3 and V4. Cardioembolic, infectious, and autoimmune etiologies were excluded. Conclusion: Although causality cannot be definitively established, this case highlights the possible association between chronic anabolic steroid use and posterior circulation ischemic stroke. AAS may induce cerebrovascular risk via vascular remodeling, vasospasm, or thrombosis.