Authors: Aasim Ali , Labeeba Abdul Ghafoor , Muhammad Numan Akram , Muhammad Shahzeb , Mukesh Kumar Sharma , Usama Saleem , Muhammad Abdullah Mushtaq , Taha Mehmood ,

Abstract

Background: Opalski Syndrome is a rare variant of lateral medullary syndrome characterized by ipsilateral hemiparesis due to medullary infarction extending into the cervical spinal cord.

Case Presentation: A 30-year-old Asian male with newly diagnosed diabetes presented with vomiting, vertigo, dysphagia, ataxic breathing, and ipsilateral facial and contralateral sensory loss. Subsequently, he developed right-sided hemiplegia. He had an ataxic respiratory pattern suggesting medullary involvement. Magnetic resonance imaging brain and cervical spine Fluid-Attenuated Inversion Recovery (FLAIR) revealed an infarction in the right medulla extending into the ipsilateral spinal cord. Stroke workup for young patients yielded negative results. A computed tomography angiography brain was done to rule out vertebrobasilar
dissection. Workup for stroke in the young was unremarkable. In addition to anti-platelets and statin; frequent blood gas analysis was performed because of his abnormal breathing pattern. Tissue plasminogen activator was not administered as the patient presented late in our stroke center, and the initial NIHSS score was 4.

Conclusion: This case emphasizes that Opalski syndrome should be considered in young stroke patients presenting with lateral medullary features and ipsilateral hemiparesis. Recognition of ataxic breathing as a clinical clue to medullary involvement can guide timely diagnosis and management.

Keywords: Opalski Syndrome, medullary infarct, hemiplegia, brainstem stroke, stroke in young