title: Repeated Transient Wallenberg's Syndrome: Probable Association with Ipsilateral Vertebral Artery Hypoplasia and Aortic Valve Disease.
abstract: BACKGROUND
  Here we report a rare case of repeated transient Wallenberg's syndrome and discuss its mechanism.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  A 57-year-old man was admitted for 1.5-month repeated transient Wallenberg's syndrome, including right-sided Horner's syndrome, lower limb weakness, and paresthesia on the right side of the body and face. His symptom appeared mostly during physical activity. Symptoms occurred nearly everyday and lasted from 5 minutes to 30 minutes. His cranial magnetic resonance imaging (MRI) including diffusion-weighted MRI imaging was normal, and his cervical contrast-enhanced magnetic resonance angiography reflected right vertebral artery hypoplasia. Twenty-four-hour electrocardiogram and electroencephalography showed no abnormalities. Echocardiography showed aortic valve calcification with moderate aortic stenosis, moderate aortic insufficiency, and dilated aorta. Dual-antiplatelets or warfarin (international normalized ratio reached 2.07) were not effective to reduce the attacks.
  
  
  CONCLUSIONS
  Hemodynamic instability due to valve disease combined with right vertebral artery hypoplasia could lead to transient Wallenberg's syndrome. Antithrombotics are often ineffective for this kind of patients and the best therapy for them could be to cure their valve disease. Repeated transient Wallenberg's syndrome is rare and that caused by ipsilateral vertebral artery hypoplasia and severe valve disease has not been reported up till now to our knowledge, so it will widen the knowledge on etiologies of transient ischemic attacks and provide information and reference to cardiologists and neurologists in diagnosis and treatment for patients with similar clinical manifestations.
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Feng-Di
authors.initials: FD
authors.lastname: Liu
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Rong
authors.initials: R
authors.lastname: Zhao
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Shuo
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Wen-Ting
authors.initials: WT
authors.lastname: Li
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Xiao-Xiao
authors.initials: XX
authors.lastname: Tao
authors.affiliation: Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Ting
authors.initials: T
authors.lastname: Sun
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR.
authors.forename: Xiao-Lei
authors.initials: XL
authors.lastname: Shen
authors.affiliation: Department of Neurology, Jiuyuan Municipal Stroke Center of Shanghai, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China PR. Electronic address: liujr021_201410@126.com.
authors.forename: Jian-Ren
authors.initials: JR
authors.lastname: Liu
mesh_terms: D001021:Aortic Valve; D000082882:Bicuspid Aortic Valve Disease; D004452:Echocardiography; D007839:Functional Laterality; D006330:Heart Defects, Congenital / Q000150:complications*; D006349:Heart Valve Diseases / Q000150:complications*; D006732:Horner Syndrome / Q000209:etiology; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications*; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D014711:Vertebral Artery / Q000473:pathology*
keywords: Aortic valve stenosis and insufficiency; Horner's syndrome; Wallenberg's syndrome; transient ischemic attack; vertebral artery hypoplasia