Corneal Involvement in Wallenberg Syndrome: Case Report and Literature Review

Abstract

A 47-year-old man with Wallenberg syndrome after a stroke in the territory of the left vertebrobasilar artery and posterior inferior cerebellar artery, presented a week later complaining of visual loss in the left eye. Examination showed corneal anaesthesia associated with a neurotrophic corneal epithelial defect. Corneal involvement secondary to trigeminal neuropathy in Wallenberg syndrome is not frequently reported and may lead to epithelial erosion and neurotrophic keratopathy. Clinicians should be aware that visual loss can occur from a neurogenic basis (e.g., Wallenberg syndrome) due to neurotrophic keratopathy. The use of cocaine, a potential cause of neurotrophic keratopathy, should also be suspected in the appropriate clinical scenario.

Keywords: Wallenberg syndrome; neurotrophic keratitis; trigeminal nucleus.

Figure 1.

External patient appearance (infrared image) when admitted, showing left-sided Horner syndrome.

Figure 2.

MRI of the brain without contrast – Axial T2-weighted image showing a left-sided stroke at the level of the lateral medulla and inferior cerebellar peduncle (arrow).

Figure 3.

Slit lamp examination of the left eye. a. At presentation, there is paracentral inferior corneal epithelial sloughing and an epithelial defect. b. At one month follow up, residual superficial punctate keratopathy and moderate stromal haze are evident.