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J Neurol Neurosurg Psychiatry 1999;67:688–689

NEUROLOGICAL PICTURE

Opalski’s syndrome
When ipsilateral hemiplegia is associated with symptoms of
a lateral medullary syndrome, it corresponds to the
submedullary syndrome of Opalski.1 Some neuropathological case reports have shown that the infarction is
located lower than that found in Wallenberg´s syndrome.2
Opalski’s syndrome has been attributed to an occlusion of
the vertebral artery.3 4 There are limited neuroradiological
studies at the literature about this syndrome.5
We report the case of a 69 year old man, without cardiovascular risk factors, who developed a sudden left headache
followed by dysarthria, dysphagia, and ataxia (falling to the
left). Neurological examination disclosed a severe dysphagia with a hoarse voice, and the uvula was pulled to the
right side. There was left facial weakness with sensory loss
at this side and the left corneal reflex was absent with an
ipsilateral miosis. Left braquiocrural hemiparesis and right
(crossed) braquiocrural sensory loss were seen. Walking
was not possible.

Magnetic resonance imaging (T2 weighted sequence),
showed a large left laterobulbar infarction (figure A). This
figure and the sagittal image (figure B) confirmed that the
left pyramidal tract was unaVected. The coronal image
(figure C) shows the caudal extension of the infarct,
involving the right pyramidal tract after crossing to the left
side. An absence of flow of the left vertebral artery is seen
on MR angiography (figure D).
Ipsilateral hemiparesis was linked to the lesion of the
lower medulla involving the ipsilateral corticospinal tract
after decussation of the pyramids. This picture diVers from
the hemimedullary infarct (Babinski-Nageotte syndrome)
in which the ipsilateral pyramidal tract is aVected before
decussation with contralateral hemiparesis.
J MONTANER
J ALVAREZ-SABÍN

Opalski’s syndrome
Cerebrovascular Unit, Department of Neurology, Vall d’Hebron Hospital,
Barcelona, Spain
Correspondence to Dr J Montaner, Cerebrovascular Unit, Department of
Neurology, Vall d´Hebron Hospital, Barcelona, Spain.
1 Opalski A. Un nouveau syndrome sous-bulbaire: syndrome partiel de
l’artère vertébro-spinale postérieur. Paris Med 1946;1:214–20.

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2 Osetowska E, Krasnicka Z. Sur le syndrome sous-bulbaire d´Opalski avec
une étude anatomique (contribution aux aspects paradoxaux du syndrome
de Wallenberg). Rev Neurol (Paris) 1961;104:314–20.
3 Dhamon SK, Iqbal J, Collins GH. Ipsilateral hemiplegia and the Wallenberg
syndrome. Arch Neurol 1984;41:179–80.
4 Romero F, Molins M, Gonzalez F, et al. Síndrome de Opalski. Estudio
clínico-radiológico de una observación. Rev Neurol 1975;10:11–16.
5 Hommel M, Pollak P, Gaio JM, et al. Imagerie par résonance magnétique et
infarctus latérobulbaire. Rev Neurol(Paris) 1988;144:272–8.