ELECTROPHYSIOLOGICAL FINDINGS IN AN IATRO GENIC CASE OF WALLENBERGS SYNDROME

We report on a 36-yr-old man who developed a left-sided Wallenberg's s yndrome immediately after a chiropractic cervical manipulation. Diagno stic investigations (MRI and Doppler ultrasound) revealed a dissection of the ipsilateral vertebral artery. Electrophysiological studies ini tially showed pathological results in the blink reflex (fig. 1), the m asseter reflex, the masseter inhibitory reflex, the trigeminal SEP (fi g. 2) and the sympathetic skin reaction (fig. 3). Three months later, most clinical symptoms had disappeared. By contrast, blink reflex, mas seter inhibitory reflex, trigeminal SEP and sympathetic skin reaction remained pathological. In consideration of the literature we conclude :(1) Chiropractic manipulations, especially the combination of hyperex tension and rotation of the neck may cause vertebral artery dissection . (2) In Wallenberg's syndrome, blink reflex, masseter inhibitory refl ex, trigeminal SEP and sympathetic skin reactions are the most useful electrophysiological methods and may indicate a brainstem lesion even after regression of clinical symptoms.