[rasheed]

In both the lateral meduallary syndrome (Wallenburg syndrome) and in the lateral pontine syndrome we have these lesions:

• Ipsilateral horner because of lesioned descending hypothalamics
• Contralateral loss of pain and temperature due to the spinothalamic tract cut
• Ipsilateral cerebellar ataxia because of a lesion in the cerebellar peduncles (inferior in the case of the medulla and middle in the case of pons)
• Vertigo, vomiting, and nystagmus due to vestibular nuclei involvement
• Ipsilateral loss of pain and temperature in the half of the face due to spinal V nucleus lesion
• Ipsilateral hearing loss due to cochlear nucleus involvement

So how to tell the difference between the two?

1. Nucleus ambiguous and nucleus solitarius with resultant loss of gag, taste, dysphagia, swallowing, etc is seen only in Wallenburg
2. Motor involvement of the Trigeminal is seen only in lateral pontine (specially if it is a rostral lesion) with ipsilateral loss of touch and mastication on the side of the face
3. Facial involvement is sometimes seen in lateral pontine but not in lateral medullary syndrome with it's loss of anterior 2/3 taste, lacrimation, facial expression, corneal reflex, and hyperacusis