Cardiocerebral infarction presenting as Opalski Syndrome: A case report

Introduction@#Opalski Syndrome is a rare type of stroke variant presenting with signs of lateral medullary syndrome plus ipsilateral hemiparesis. A confirmed myocardial infarction simultaneously occurring with this acute ischemic stroke syndrome makes this an even more challenging case of Cardiocerebral infarction.@*Case@#The patient is a 48-year-old female, a known diabetic and asthmatic, and was seen due to a 3-day history of sudden onset of non-rotatory dizziness associated with diplopia, non-projectile vomiting, numbness of the left side of the face and lingual dysarthria. She was initially admitted in a primary hospital wherein she developed chest pain, dyspnea and diaphoresis. She was transferred and was received with findings of miosis of the left eye, rotational nystagmus, left dysmetria, decreased pain and temperature sensation on the right extremities, left central facial palsy, tongue deviation to the left side, left hemiparesis and upward Babinski on the left. We localize this lesion on the left lateral medullary area with involvement of the caudal left corticospinal tract. Hence, a clinical impression of Opalski Syndrome was made. This was confirmed with cranial MRI findings of T2/FLAIR hyperintense focus involving the left lateral aspect of the medulla. The patient’s Troponin I was also elevated and she was managed as a case of acute coronary syndrome - NSTEMI. Hence, a diagnosis of Type III Cardiocerebral infarction was made. Medical intervention was started with dual antiplatelet therapy and anticoagulation with noted clinical improvement. @*Conclusion@#This case report highlights the diagnosis of Opalski Syndrome in a patient also presenting with Cardiocerebral infarction. There should be prompt recognition of the following disease entities to have an effective treatment, avoid cardiac and neurologic sequelae, and achieve an overall favorable prognosis.

Lateral medullary syndrome: an unwanted ischemia to identify early

Lateral medullary syndrome also referred to asWallenberg syndrome, posterior inferior cerebellar artery (PICA) syndrome, orvertebral artery syndrome is a cluster of neurological symptoms and signs brought on by obstructions in the blood vessels supplying the medulla, which causes ischemia or infarction of the brainstem. The vertebral artery or the posterior inferior cerebellar artery are the arteries most frequently affected with lateral medullary syndrome. The most prevalent symptom istransient ischemic attack (TIA) with dizziness or vertigo andatherosclerosis in the posterior cerebral circulationbeingthe most common cause. Lateral Medullary Syndrome patients sufferfrom strokes or infarction and alsopresentwith vomiting,nausea, gait impairment, instability, hoarseness, and swallowing difficulties. Depending on the particular nuclei and fibersinvolved, different indications will appear. CT/MRI imaging is used to diagnose conditions. The majority of management is supportive, including risk factor reduction for additional ischemia events as well as speech and occupational therapy following an acute intervention. In this review article, we discuss the etiopathogenesis and factors leading to lateral medullary syndrome along with a comprehensive discussion on its clinical features, challenges in diagnosis, and treatment.

Response of astrocytes and neurons in rat medullary visceral zone to the spared nerve injury / 解剖学报

Objective To investigate the response of astrocytes and neurons in the medullary visceral zone (MVZ) to neuropathic pain induced by the spared nerve injury (SNI, the tibial nerve and the common peroneal nerve were sectioned, while the sural nerve was intacted). Methods The SNI operation and sham operation (only incised the skin of thigh, but the tibial nerve and the common peroneal nerve did not cut) were performed in adult male Sprague-Dawley rats. The paw withdrawal mechanical threshold (PWMT) was measured at 10,20,30 days after operation. By using single or double immunofluorescent staining method,we investigated and measured that the mean fluorescent intensity (MFI) of anti-glial fibrillary acidic protein (GFAP, a marker of astrocytes) signal in the astrocytes, the mean member of Fos/ GFAP double labeled astrocytes and Fos / tyrosine hydorxylase (TH) double labeled neurons in MVZ after operation. Results As compared with control or sham groups, SNI induced that the PWMT became significant sensitivity and peaked at 20 days after SNI. The activated astrocytes revealed an activated morphology, the MFI of anti-GFAP signal markedly strengthened, the mean number of Fos/GFAP double labeled astrocytes and Fos/TH double labeled neurons in the nucleus of the tract solitarius (NTS) and the ventral lateral medulla (VLM) increased significantly and peaked at 20 days after SNI. Conclusion The neurons and astrocytes in MVZ were sensitively activated by SNI.