Cardiac arrhythmia is a rare manifestation of the Wallenberg syndrome; lesions are located in the brainstem, especially the lower medulla, which regulates sympathetic and parasympathetic activity. A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla. Therefore, he was diagnosed with Wallenberg syndrome. While he underwent conservative treatment for Wallenberg syndrome, he experienced several events of self-limiting heart pounding, which required an evaluation of cardiac function. The 24-hour Holter monitor showed an increased RR interval with bradycardia and prolonged sinus pause. As a result, the diagnosis of sick sinus syndrome combined with Wallenberg syndrome was made. Sick sinus syndrome is a rare cardiac complication of the Wallenberg syndrome, and clinicians could overlook it when the initial electrocardiography shows a normal sinus rhythm. Sick sinus syndrome can cause sudden death without appropriate medical intervention. Therefore, clinicians should consider further evaluation, including a 24-hour Holter monitor, to check for the potential presence of sick sinus syndrome in the acute phase of Wallenberg syndrome.

BACKGROUND: Taste disorder is a common symptom in the general population. Several studies have shown that patients with neurological disorders, such as amyotrophic lateral sclerosis and Parkinson\'s disease, develop taste disturbance. Facial onset sensory and motor neuronopathy (FOSMN) is a rare disease characterized by sensory disturbance and weakness spreading from the face to the limbs caudally. We describe a patient with FOSMN who showed taste disorder as the sole initial symptom.
METHODS: A 49-year-old man who smoked cigarettes developed taste disturbance. Despite using zinc supplements, an herbal medication, and an ointment, his taste disorder worsened. 4 years later, a tingling feeling emerged at the tip of his tongue and gradually spread to his entire lips. At 55 years of age, he showed difficulty in swallowing, followed by facial paresthesia, muscle atrophy, and weakness in the face and upper limbs without apparent upper motor neuron sign. Cessation of smoking did not improve his taste disturbance, and he was unable to discriminate different tastes on the entire tongue. In an electrogustometric study, electrical stimulation did not induce any type of taste sensation. Blink reflex showed delayed or diminished R2 responses. Needle electromyography revealed severe chronic neurogenic changes in the tongue and masseter muscles. Mild chronic neurogenic changes were also observed in the limbs. In the thoracic paraspinal muscles, active neurogenic changes were detected. Findings of hematological and cerebrospinal fluid analyses, and magnetic resonance images of the brain and spinal cord were unremarkable. One cycle of intravenous immunoglobulin therapy did not improve his symptoms. We diagnosed him as having FOSMN with the sole initial symptom of taste disorder. Nine years after the onset of taste disorder, he developed impaired sensation of touch in the right upper limb and required tube feeding and ventilator support.
CONCLUSIONS: Taste disorder can be the initial manifestation of FOSMN and might involve the solitary nucleus.

BACKGROUND: Cannabinoid hyperemesis syndrome (CHS) is characterized by symptoms of cyclic abdominal pain, nausea, and vomiting in the setting of prolonged cannabis use. The transient receptor potential vanilloid 1 (TRPV1) receptor may be involved in this syndrome. Topical capsaicin is a proposed treatment for CHS; it binds TRPV1 with high specificity, impairing substance P signaling in the area postrema and nucleus tractus solitarius via overstimulation of TRPV1. This may explain its apparent antiemetic effect in this syndrome.
OBJECTIVE: We describe a series of thirteen cases of suspected cannabis hyperemesis syndrome treated with capsaicin in the emergency departments of two academic medical centers.
METHODS: A query of the electronic health record at both centers identified thirteen patients with documented daily cannabis use and symptoms consistent with CHS who were administered topical capsaicin cream for symptom management.
RESULTS: All 13 patients experienced symptom relief after administration of capsaicin cream.
CONCLUSIONS: Topical capsaicin was associated with improvement in symptoms of CHS after other treatments failed.