Opalski's Syndrome with Cerebellar Infarction

Area of Science:

• Neurology
• Neuroimaging
• Vascular Neurology

Background:

• Lateral medullary infarction, often associated with vertebral artery dissection or occlusion, can present with diverse neurological deficits.
• Cerebellar infarction can occur secondary to vertebrobasilar system compromise.
• Opalski's syndrome is a rare presentation of lateral medullary infarction.

Purpose of the Study:

• To report a case of concurrent lateral medullary and cerebellar infarction.
• To highlight the clinical and radiological findings in a patient with Opalski's syndrome and vertebral artery pathology.

Main Methods:

• Clinical presentation and neurological examination findings were documented.
• Diffusion-weighted magnetic resonance imaging (MRI) was used to identify acute infarcts.
• Magnetic resonance angiography (MRA) assessed the vertebral arteries for stenosis or occlusion.

Main Results:

• The patient presented with acute right-sided hemiparesis, Horner syndrome, ataxia, and sensory loss.
• MRI confirmed an acute right lateral medullary infarction and a cerebellar infarction in the posterior inferior cerebellar artery territory.
• MRA revealed severe stenosis/near occlusion of the right vertebral artery and left vertebral artery hypoplasia.

Conclusions:

• This case illustrates a rare presentation of ipsilateral hemiparesis with lateral medullary infarction (Opalski's syndrome) and cerebellar infarction.
• Vertebral artery stenosis/occlusion is a critical underlying vascular pathology in such presentations.
• Prompt neuroimaging is essential for diagnosing complex stroke patterns involving the brainstem and cerebellum.