The aim of this case report of a 47-year-old woman who suffered from
acute right-sided medullar ischemic stroke was to define the range of visual
impairment in Wallenberg’s syndrome (WS). The patient complained of unbearable
environmental tilt and rotating visual perception. On examination, 11 months
following the stroke, the patient manifested rightsided postural inclination
and gaze ipsipulsion. The fixation in primary position was unstable, after a
conjugate ipsipulsion ensued, spontaneous corrective saccades and a
horizontal-rotational jerking nystagmus beating away from the side of the
lesion were generated. Monocular visual acuity (right eye: 0.4 logMAR distance
and 0.2 logMAR near; left eye: 0.1 logMAR distance and 0.0 logMAR near) was
significantly better than binocular (0.63 logMAR distance and near). Fluent reading
was impossible. Contralateral smooth pursuits were more impaired. Saccades were
defective manifesting right hypermetria and left hypometria. Visual field was
constricted to central 10 – 20°. A diagnosis of Wallenberg’s syndrome was made.
Occlusion was prescribed. Review of literature demonstrated lack of
evidence-based guidelines for ophthalmic assessment and treatment of visual
impairment in WS. Oculomotor abnormalities, oscillopsia and tilt illusion cause
significant impact to daily life. Early post-stroke ophthalmological evaluation
is thus mandatory in order to offer timing treatment.