530 - Meningioma Resection: An Atypical Cause of Wallenberg Syndrome

A 38-year-old female was admitted to an inpatient rehabilitation facility (IRF) after retroclival meningioma resection. Post-operative imaging revealed mass effect with sulcal effacement and partial effacement of the basal cisterns without midline shift. Due to tumor location, after resection the patient developed right cranial nerve 6 palsy with impaired pupillary response, right hemifacial numbness, dysphagia requiring gastrostomy tube, dysphonia, vestibular symptoms (nausea and vertigo), diminished sensation to light touch on the left upper extremity, and gait ataxia.

She was previously independent for all activities of daily living (ADLs) and mobility. On initial therapy evaluation the patient required moderate assistance with mobility and minimal assistance with ADLs.  She participated in physical therapy to address vertigo and ataxia, occupational therapy/optometry for ADLs and vision, and speech therapy/otorhinolaryngology for dysphagia and dysphonia. At discharge she was independent for mobility and ADLs, upgraded to a modified oral diet, and transitioned to outpatient therapy.

Discussions:

Wallenberg syndrome, or lateral medullary syndrome, typically presents as a rare stroke syndrome, however in this case it was seen after tumor resection due to the location. For our patient, post operative impairments included pupillary response due to disruption of the oculosympathetic chain, right facial numbness due to disruption of CN 5, dysphagia, and dysphonia due to disruption of CN 9 and 10, tongue deviation due to disruption of the hypoglossal nucleus, and nausea and vertigo due to vestibular nuclei involvement. Acute inpatient rehabilitation was able to address the full scope of her functional deficits and discharge her home at the independent level.

Conclusions:

Patients with Wallenberg syndrome require a comprehensive team-based approach to address their neurological deficits and improve their overall function.