Our patient is a 65-year-old male with a medical history of hypertension and hyperlipidemia, who was brought in by emergency medical services complaining of right-sided facial droop, slurred speech, and left-sided weakness of one-day duration. Early detection, management, and rehabilitation are critical for improving post-stroke recovery. Wallenberg syndrome has the potential to leave patients extremely debilitated. MRI with DWI is the gold standard to confirm the diagnosis. The neurological deficits associated with this disease are due to damage of the lateral medulla, inferior cerebellar peduncle, nucleus of trigeminal nerve, nucleus and fibers of vagus and glossopharyngeal nerves, descending sympathetic tract, spinothalamic tract, and/or vestibular nuclei. Wallenberg syndrome, also known as lateral medullary syndrome or posterior inferior cerebellar artery syndrome, is a constellation of symptoms caused by posterior vascular accidents. In light of such a high suspicion for stroke based on the patient’s neurologic deficits, a repeat MRI of the brain was performed three days later and exposed a small focus of bright signal (hyperintensity) on T2-weighted fluid-attenuated inversion recovery and diffusion-weighted imaging (DWI) in the left posterior medulla. An initial magnetic resonance imaging (MRI) of the brain with and without contrast revealed no abnormality. Physical examination showed decreased left arm and leg strength compared to the right side, decreased left facial temperature sensations, decreased left arm and leg temperature sensations, and difficulty sitting upright with an associated leaning towards the left side. Our patient is a 65-year-old male who was brought in by emergency medical services complaining of right-sided facial droop, slurred speech, and left-sided weakness for one day. We present an atypical case of Wallenberg syndrome in which the initial MRI of the brain was normal. Diagnosis of Wallenberg syndrome is often overlooked as initial MRI may show no visible lesion. Wallenberg syndrome is the most common stroke of the posterior circulation.
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