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.

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.

Opalski Syndrome Presenting as Sensorimotor Deficits Ipsilateral to Cerebral Infarction

Opalski syndrome is a rare lateral medullary infarction variant presenting with ipsilateral motor deficits known to be caused by involvement of the post-decussating pyramidal tract. Here, we report two rare cases of Opalski syndrome presenting as ipsilateral sensorimotor deficits in cerebral infarction.

Opalski's Syndrome with Cerebellar Infarction

A 64-year-old man presented with sudden onset of right-sided hemiparesis, headache, gait disturbance, and recurrent vomiting. A physical examination revealed right-sided hemiparesis, right Horner syndrome, ataxia of the right limbs, and diminished sensation on the left side of his body. Diffusion-weighted MRI revealed an acute right lateral medullary infarction extending from the rostral medulla to the upper cervical cord, and an acute cerebellar infarction in the territory of the medial branch of the posterior inferior cerebellar artery. Magnetic resonance angiography revealed suspicious severe stenosis or near occlusion of the proximal and distal parts of the right vertebral artery, and hypoplasia of the left vertebral artery. We diagnosed ipsilateral hemiparesis with lateral medullary infarction (Opalski's syndrome) and concomitant cerebellar infarction.