Portable Thermographic Screening for Detection of Acute Wallenberg's Syndrome
September 19th, 2019
Acute Wallenberg's syndrome can be misdiagnosed as a non-stroke disease, such as auditory vertigo. Thus, careful neurological examination, which is sometimes difficult for non-neurologists, is necessary for precise diagnosis. Here, we present a simple, rapid, noninvasive, and cost-effective method for detection of acute Wallenberg's syndrome using portable thermography.
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.
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Overview
This study focuses on a simple and rapid method to detect acute Wallenberg's syndrome, which can often be misdiagnosed as a non-stroke condition. The technique utilizes portable thermography, offering a non-invasive and cost-effective approach for accurate diagnosis, essential for neurological examination.
Key Study Components
Area of Science
- Neurology
- Diagnostic Techniques
- Thermography
Background
- Wallenberg's syndrome results from the infarction of the lateral medulla.
- It can easily be misdiagnosed as conditions like auditory vertigo.
- A careful neurological examination is crucial for accurate diagnosis.
- Portable thermography offers a way to improve diagnostic accuracy.
Purpose of Study
- To present a novel method for detecting Wallenberg's syndrome.
- To enhance early screening techniques for neurological conditions.
- To reduce misdiagnosis rates in patients with stroke-like symptoms.
Methods Used
- Portable thermography is the main platform used for detection.
- Patients exhibiting symptoms such as dizziness, vertigo, and dysphagia are selected for screening.
- Thermographic measurements are taken of body surface temperatures.
- Important steps include patient positioning and image acquisition techniques.
Main Results
- Thermography may identify laterality in body temperatures, which correlates with Wallenberg's syndrome.
- Any notable temperature differences across the body may indicate the presence of the syndrome.
- However, a negative result does not rule out the syndrome; neurological examination is still required.
- Findings can aid in refining initial diagnostic steps for patients.
Conclusions
- This method facilitates preliminary screening for Wallenberg's syndrome.
- Though helpful, it cannot replace comprehensive neurological evaluations.
- The implications suggest improved diagnostic pathways for stroke conditions.
Frequently Asked Questions
Executive Industry Relevance
Portable thermography offers a rapid, non-invasive screening tool for acute Wallenberg's syndrome, addressing a critical gap in early stroke detection for non-neurology settings. By identifying lateral body surface temperature differences, the method supports preliminary risk stratification before confirmatory neurological workup. This approach reduces diagnostic delays and misclassification of brainstem infarction as non-stroke conditions like auditory vertigo, improving triage efficiency in emergency and primary care environments.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables interrogation of autonomic dysfunction pathways linked to lateral medullary infarction through measurable physiological biomarkers.
- Operational Value: Provides a quantifiable, bedside-assessable phenotype for validating targets involved in thermoregulatory and sympathetic nervous system modulation.
Screening & Assay Development
- Scientific Value: Generates standardized, reproducible thermal readouts across anatomical sites (face, palm, abdomen, foot) for consistent phenotypic screening.
- Operational Value: Supports assay-like workflows with defined measurement protocols, threshold criteria (>0.5°C laterality), and bilateral comparison logic.
Translational & Preclinical Research
- Scientific Value: Models disease-relevant autonomic dysfunction in preclinical stroke models by correlating infarct location with thermal laterality patterns.
- Operational Value: Facilitates cross-species translation of thermographic screening as a non-invasive functional readout for neurovascular compound evaluation.
Pipeline & Workflow Integration
The method fits within early discovery workflows as a phenotypic screening tool that precedes mechanistic de-risking and lead identification stages, particularly for CNS-targeted therapies addressing autonomic dysregulation.
- Discovery Biology: Supports hypothesis testing of brainstem lesion models by providing a functional, physiologically grounded readout of sympathetic disruption.
- Screening: Enables standardized, high-reproducibility phenotyping of thermal asymmetry in disease models using portable infrared imaging.
- Analytics: Delivers quantitative, continuous temperature differentials that allow objective comparison across experimental conditions and treatment groups.
- Translational Research: Aligns with biomarker continuity by linking thermal laterality to clinical symptomology in Wallenberg's syndrome, aiding preclinical-to-clinical translation.
- Enterprise Reuse: Represents a portable, low-cost platform adaptable across therapeutic areas requiring autonomic or peripheral nervous system phenotyping.
Operational & Enterprise Impact
- Scientific Value: Enhances predictive confidence by reducing mechanistic ambiguity in autonomic nervous system involvement in brainstem pathology.
- Operational Value: Enables standardization across sites with minimal training, rapid deployment, and no consumables beyond device charging.
- Strategic Value: Improves go/no-go decision efficiency in early neurovascular programs by filtering false-positive phenotypes lacking autonomic signatures.
- Portfolio Impact: Enables risk-adjusted prioritization of compounds targeting lateral medullary pathways by enriching for mechanistically relevant models.
Implementation Considerations
- Requires basic training in thermal camera operation and standardized patient positioning for consistent image acquisition.
- Dependent on portable infrared camera with real-time center-spot measurement and color palette (iron/rainbow) selection capabilities.
- Necessitates cross-site protocol alignment for bilateral measurement at four anatomical sites and subjective laterality assessment.
- Adaptation considerations include variations in ambient temperature, patient clothing, and diaphoresis that may affect baseline thermal readings.
- Limited sensitivity in cases of small infarct size where thermal laterality may fall below detectable threshold (<0.5°C), necessitating neurological confirmation.
