Abstract Lateral medullary syndrome (LMS) typically spares motor pathways. Opalski syndrome is a rare variant characterized by ipsilateral hemiparesis due to caudal extension of infarction below the pyramidal decussation. We report a 55-year-old male presenting with vertigo, dysarthria, ataxia, ipsilateral hemiparesis, and contralateral sensory loss. MRI revealed infarction of the right posterolateral medulla with bilateral cerebellar involvement, while CT angiography demonstrated a hypoplastic and occluded right vertebral artery with non-visualization of the posterior inferior cerebellar artery. The patient developed bulbar dysfunction requiring ventilatory support and had a severe clinical course. This case highlights ipsilateral hemiparesis as a diagnostic pitfall and suggests that extensive vascular involvement and bilateral cerebellar infarction may be associated with poorer outcomes in Opalski syndrome.
Gupta et al. (Thu,) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: