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Título

Opalski syndrome in left bulbar ischemic stroke: case report

RESUMO

Case presentation: A 50-year-old male patient started ten days ago with intense headache in the left frontal region, tightness, with nausea and vomiting. Symptoms worsened after four days, with loss of left lower limb strength and vertical diplopia. On physical examination, Horner syndrome on the left, with miosis and ptosis; skew deviation with hypotropia in the left eye; complete left spastic hemiparesis predominantly in the left lower limb; alternating thermal and painful hemihypoesthesia was also observed, alternating with involvement of the left hemiface and right limbs. Brain MRI showed an ischemic stroke in the lateral region of the left medulla. Discussion: Opalski syndrome is a rare variant of lateral bulbar infarction, characterized by the triad of ipsilateral hemiparesis, Babinski sign and contralateral hypothermalgesia. Although our patient did not have Babinski's sign, he did have spasticity, which corroborates the involvement of the pyramidal tract. Lateral bulbar lesions may present with diplopia, nystagmus, and bias deviation due to involvement of the vestibular pathways. Final comments: In cases of stroke with hemiparesis, diplopia and asymmetric deviation, with contralateral sensory changes, Opalski's syndrome due to lateral bulbar involvement should be considered.