Opalski syndrome and ipsilateral peripheral type facial palsy in lateral medullary infarction: a case report

Abstract

A 48-year-old man was admitted in our hospital with chief complaints of left-sided hemiparesis and dysarthria. A physical examination revealed decreased thermal nociception on left face and right limbs, dysarthria, left peripheraltype facial palsy, motor paresis of the left upper and lower limbs, and ataxia of the left limbs. Initial diffusion weighted-imaging MRI showed a high-intensity signal in the left lateral medulla oblongata. Magnetic resonance angiography and 3D computed tomography angiography revealed occlusion of the left distal vertebral artery. We diagnosed the patient as left lateral medullary infarction known as Opalski syndrome. Based on the clinical course, we considered that the regional perfusion failure in the peri-infarct area due to vertebral artery occlusion may have caused ipsilateral peripheral-type facial palsy and hemiparesis in this case. Ipsilateral motor and/or facial nerve can be disturbed by lateral medulla oblongata infarction resulted from vertebral artery stenosis or occlusion.