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.