Mansour Marah, Alwaw Ricarda, Almaalouli Bsher, Qasem Yasmine, Hassan Khalil, Charaf Obada, Chama Mohd Beshr, Mansour Nawar Akramah, Allabwani Abd Alqader, Hammad Yousha
Faculty of Medicine, University of Tartous, Tartous.
Division of Colon and Rectal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
Ann Med Surg (Lond). 2024 Jun 18;86(8):4825-4831. doi: 10.1097/MS9.0000000000002239. eCollection 2024 Aug.
Opalski syndrome is a rare variant of Wallenberg syndrome (lateral medullary syndrome) that demonstrates concomitant ipsilateral hemiplegia due to infarctions within the lateral medulla and the cervical spinal cord, which also extend to the post-pyramidal decussation to affect the corticospinal tract.
A 56-year-old man initially presented with a unilateral headache with right cervical pain. Consequently, he developed symptoms that indicate Wallenberg syndrome: vertigo, dysphonia, dysarthria, right limb ataxia with a tendency to fall, and ptosis, in addition to ipsilateral hemiparesis. The diffusion-weighted imaging MRI (DWI MRI) performed initially demonstrated an acute infarct in the dorsolateral medulla. Accordingly, an axial T2-weighted MRI showed a hyperintense focal region in the same area, even as magnetic resonance angiography (MRA) revealed complete stenosis of the corresponding vertebral artery.
Opalski syndrome can result from different etiologies such as vascular occlusion or dissection. Although symptoms may vary, patients commonly present with sudden weakness, vertigo, and gait instability. Diagnosis often relies on MRI or DW-MRI. Treatment is tailored depending on individual factors and may involve medications and monitoring. Complications like respiratory failure can occur but are not directly linked to Opalski syndrome. Proper management includes addressing ischemic risk factors and ensuring appropriate nutrition.
This case highlights the importance of including Opalski syndrome early in the differential diagnosis of patients with clinically suspected ipsilateral lateral medullary infarction and hyperacute ipsilateral hemiparesis.
奥帕尔斯基综合征是延髓背外侧综合征（瓦伦贝格综合征）的一种罕见变体，由于延髓外侧和颈髓梗死，同时伴有同侧偏瘫，梗死还延伸至锥体交叉后影响皮质脊髓束。
一名56岁男性最初表现为单侧头痛伴右侧颈部疼痛。随后，他出现了提示延髓背外侧综合征的症状：眩晕、发音困难、构音障碍、右侧肢体共济失调伴跌倒倾向、上睑下垂，以及同侧偏瘫。最初进行的扩散加权成像磁共振成像（DWI MRI）显示延髓背外侧急性梗死。相应地，轴向T2加权磁共振成像显示同一区域有一个高信号灶，而磁共振血管造影（MRA）显示相应椎动脉完全狭窄。
奥帕尔斯基综合征可由血管闭塞或夹层等不同病因引起。尽管症状可能有所不同，但患者通常表现为突然无力、眩晕和步态不稳。诊断通常依赖于MRI或DW-MRI。治疗根据个体因素进行调整，可能包括药物治疗和监测。呼吸衰竭等并发症可能发生，但与奥帕尔斯基综合征无直接关联。适当的管理包括处理缺血危险因素和确保适当营养。
本病例强调了在临床怀疑同侧延髓梗死和超急性同侧偏瘫患者的鉴别诊断中早期纳入奥帕尔斯基综合征的重要性。
