Opalski Syndrome:

A Case Study

Abstract

Opalski Syndrome (OS) is an unusual presentation of
Lateral Medullary Syndrome (LMS) with ipsilateral hemiparesis.
We report the case of a 65-year-old woman with a background
of unprovoked deep venous thrombosis and unintentional
weight loss that presented after a one-week-long episode of
sudden onset vertigo, frontotemporal headache, blurry vision,
and weakness. A head magnetic resonance imaging (MRI)
revealed subacute ischemic event, with flow-void loss in the
right vertebral artery and absence of blood flow, suggesting OS
secondary to likely right posterior inferior cerebellar artery
(PICA) occlusion. An abdominal and thoracic computed
tomography (CT) scan showed suggestive findings of stage IV
pancreatic tail cancer. Because of its non-classical presentation,
OS might be a diagnostic challenge to most physicians. As in
this patient, the existence of concomitant cancer probably led to
a hypercoagulable state, which could explain the ischemic
stroke while on anticoagulation therapy.