BMJ Case Reports 2009; doi:10.1136/bcr.02.2009.1625
  • Unusual presentation of more common disease/injury

Recurrent cardiac arrest caused by lateral medulla oblongata infarction

  1. Philipp von Heinemann1,
  2. Oliver Grauer1,
  3. Gerhard Schuierer2,
  4. Markus Ritzka1,
  5. Ulrich Bogdahn1,
  6. Bernhard Kaiser1,
  7. Felix Schlachetzki1
  1. 1
    University of Regensburg, Neurology, Universitaetsstr.84, Regensburg, 93053, Germany
  2. 2
    University of Regensburg, Center for Neuroradiology, Universitaetsstr. 84, Regensburg, 93053, Germany
  1. Felix Schlachetzki, felix.schlachetzki{at}
  • Published 12 October 2009


Cardiac arrest is a rare complication in Wallenberg syndrome, despite the fact that the brainstem, especially the lower medulla, modulates sympathetic and parasympathetic activity. In the case reported here, a 45-year-old man was admitted with clinical symptoms of Wallenberg syndrome, including right sided hemiparesis secondary to dissection of the right vertebral artery. During the following days he experienced several spells of self limiting cardiac arrests, which made the implantation of a pacemaker necessary. Magnetic resonance imaging scan showed an infarction on the lower right and dorsolateral medulla. This might have affected the central sympathetic neurons which normally inhibit the nucleus of the solitary tract. The disinhibition of the nucleus tractus solitarii may have led to an increase of parasympathetic outflow resulting in bradycardia/asystolia. This case report describes a rare indication for transient or permanent therapy with a cardiac pacemaker in Wallenberg syndrome.


  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication

Responses to this article

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article