Vertebral Artery Occlusion Causing Facial Colliculus and Opalski Stroke Syndromes Simultaneously

Brainstem stroke syndromes refer to a group of vascular disorders that occur secondary to occlusion of small perforating arteries of the posterior circulation. Although such syndromes result in a characteristic clinical picture, they are challenging to localize. In practice, such syndromes are rarely seen in their pure form, and the clinical consequences of a given vascular lesion are probably less predictable than for arteries in the anterior circulation. If 2 or more brainstem strokes happen simultaneously, localization becomes much harder. In this article, we present a case with 2 embolic strokes that occurred simultaneously because of left vertebral artery occlusion. The first in the right facial colliculus causing right sixth and seventh cranial nerves' palsy. The second happened in the left lateral medulla extending below the pyramidal decussation causing a classic left lateral medullary syndrome with ipsilateral hemiparesis, which constitutes a left Opalski stroke syndrome. To our knowledge, this is the first reported case of these 2 brainstem stroke syndromes happening simultaneously.