Co-Occurrence of High Degree Atrioventricular Block and Facial Pain in Lateral Medullary Stroke Volume 4 - Issue 4

Shairin Sihabdeen¹, Elisa Ventura², Carlo W Cereda¹, Claudio Staedler¹, Giacomo Chiaro^1,3 and Mauro Manconi^3,4,5*

• ¹Department of Neurology and Stroke Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
• ²Department of Neuroradiology, Neurocenter of Southern Switzerland, Lugano, Switzerland
• ³Sleep Center, Neurocenter of Southern Switzerland, Lugano, Switzerland
• ⁴Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
• ⁶Department of Neurology, University Hospital Inselspital, Bern, Switzerland

Received: October 05, 2020;   Published: October 14, 2020

Corresponding author: Mauro Manconi, Sleep Medicine, Neuro-center of Southern Switzerland, Regional Hospital of Lugano, Via Tesserete 46, 6903 Lugano, Switzerland

DOI: 10.32474/OJNBD.2020.04.000195

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Abstract

Background: Besides the typical alternate clinical picture, Wallenberg syndrome may be rarely associated with facial pain due to the involvement of the trigeminal nucleus, and sudden death.

Case: We report a case of lateral medullary infarction associated with potentially life threatening intermittent high degree atrioventricular block which occurred in close temporally association with severe facial pain exacerbations. The case required an urgent implantation of cardiac pacing. We hypothesized that the AV-block was triggered by vasovagal response to centrally-mediated pain. However, a direct involvement of the autonomic brainstem network (solitary tract nucleus and dorsal motor nucleus) could not be excluded.

Conclusion: A similar sequence of events might explain at least part of the unexplained sudden deaths that seldom accompany Wallenberg syndrome. This report highlights the importance of continuous cardiac monitoring, in the acute phase of lateral bulbar ischemia, in order to prevent unfavorable outcome.

Keywords: Wallenberg Syndrome; Facial Pain; Trigeminal Nucleus; Atrio-Ventricular Block; Cardiac Arrythmia; Vaso-Vagal Response

Abstract| Introduction| Case Report| Discussion| Conflicts of Interests| References|