Wallenberg's syndrome is caused by the infarction of the lateral medulla and is sometimes misdiagnosed as non-stroke disease. Using portable thermography may help prevent the misdiagnosis of this neurological condition. This method is a very simple, rapid, non-invasive and cost-effective technique that allows the possibility of Wallenberg's syndrome to be easily determined.
Before beginning the measurements, charge and turn on the thermal camera. Press the center button on the camera to display the menu and select the color in iron or rainbow. Then press the center button on the camera to display the menu again and select measurement and center spot measurement to allow measurement of the body surface temperature in real time.
For Wallenberg's syndrome screening select patients with dizziness, vertigo, ptosis, hoarseness, dysphagia, and isochoria or dissociated sensory disturbance as all of the symptoms have been associated with Wallenberg's syndrome. It is important to measure the body surface temperature by thermography in any patient in which Wallenberg's syndrome is suspected. To subjectively determine the laterality of the body surface temperature first palpate patients with suspected Wallenberg's syndrome.
To acquire thermographic images instruct the patient to remove their socks and shoes and have the patient remove enough clothing to enable examination of the abdominal region as per their consent. As soon as Wallenberg's syndrome is suspected have the patient assume a supine posture, or sitting position, and have a photographer hand 50 to 100 centimeters from the patient. Then have the photographer acquire one image each at the frontal face, bilateral palm, abdomen, and bilateral dorsum of the foot.
Consider body surface temperature to exhibit laterality when the body surface temperature between the right and left sides is markedly different macroscopically and the degree of laterality is greater than a half of a degree Celsius. If laterality of the body surface temperature is not obvious or appears to be less than half of a degree Celsius initialize the thermal imaging and analysis software and open the acquired images to be analyzed. Use the ellipse measurement button to indicate ellipses with diameters of greater than five millimeters at that nasolabial fold on the face, the palm of the hand, the thoracic spine levels eight to 10 approximately five centimeters from the umbilicus of the torso, and at the center of the dorsum of the foot.
Then measure the average body surface temperature from each location and compare it to the body surface temperature on the contralateral side of the body. Some patients exhibit laterality of the body surface temperature throughout the body, whereas some exhibit laterality in only a few locations. The warmer side, as determined by the body surface temperature, is ipsolateral to the location of Wallenberg's syndromes.
Importantly however, a Wallenberg's syndrome patient with a very small infarction may not exhibit body surface temperature laterality. When a patient does not exhibit a central nervous disorder laterality of the body surface temperature is typically not observed. However, when a patient exhibits vascular stenosis the body surface temperature maybe be lower in the extremities with vascular stenosis than in extremities on the contralateral side, and these patients may exhibit vascular stenosis in both the upper and lower limbs.
The precise degree of the body surface temperature can be analyzed with dedicated software and may be required when the laterality of the body surface temperature is not apparent macroscopically. It is important to remember that this method is used for the screening of Wallenberg's syndrome, not for confirming the diagnosis of Wallenberg's syndrome. To confirm a Wallenberg's syndrome diagnosis a careful neurological examination and repeated brain stem MRIs are needed.
Consider hospitalization when the possibility of Wallenberg's syndrome cannot be excluded.
