Upside down words as initial clinical presentation of an underlying acute ischemic stroke

@#We report a diabetic patient who was diagnosed with an acute stroke who presented with a 3-day history of difficulty of reading, described as the words were turned upside down, as if the words were inverted horizontally with associated right homonymous hemianopia and multiple higher cortical function deficits (alexia without agraphia, achromatopsia, prosopagnosia). He has poorly controlled diabetes and hypertension. Cranial magnetic resonance imaging (MRI) revealed an acute infarct on the left posterior cerebral artery territory. The patient was managed as an acute ischemic stroke and follow up after 6 months revealed improvement of the visual field cut but with persistence of the higher cortical function deficits. To the best of our knowledge, we report the first rare occurrence reversal of vision metamorphopsia described as inverted words as the sole initial presentation of an underlying stroke.

Case series and literature review of Opalski syndrome: A rare brainstem stroke

@#A rare type of lateral medullary infarction, the Opalski Syndrome is weakness ipsilateral to the lesion of the infarct. The lesion involves the ipsilateral corticospinal tract below the pyramidal decussation. We report the first two known documented case in the Philippines, admitted on the same tertiary hospital almost one year apart.