Wallenberg Syndrome Secondary to Vertebrobasilar Aneurysm Associated With Subclavian Steal Syndrome

Wallenberg syndrome, also known as lateral medullary syndrome, is a rare condition affecting the vertebrobasilar circulation, causing symptoms such as vertigo, nystagmus, dysarthria, and hemifacial weakness. Typically linked to ischemic strokes, it can also arise from vertebrobasilar aneurysms. In rare cases, subclavian steal syndrome (SSS), involving retrograde flow in the vertebral artery due to subclavian stenosis, complicates the picture, as observed in this case of a 66-year-old woman with both conditions and a vertebrobasilar aneurysm. This study was conducted at the Neurosurgery Department of Centro Médico Nacional 20 de Noviembre, Mexico City. The patient, a 66-year-old woman with hypertension and chronic smoking, presented with vertigo, diplopia, and quadriparesis. Imaging revealed a vertebrobasilar aneurysm and SSS. Despite recommendations for further invasive studies, the patient declined angiography and therapeutic interventions, opting for voluntary discharge without treatment. This case underscores the rare association of Wallenberg syndrome with a vertebrobasilar aneurysm and SSS. Hemodynamic stress from retrograde vertebral artery flow likely contributed to aneurysm formation. Advanced imaging is vital for diagnosis, and while the patient refused treatment, multidisciplinary management, including future innovations such as three-dimensional printing and endovascular techniques, holds promise for improving outcomes in such complex cases.