NEUROIMAGES

Opalski syndrome
Ipsilateral hemiplegia due to a lateral-medullary infarction

Downloaded from https://www.neurology.org by 76.8.222.100 on 12 April 2024

Figure

Imaging features of Opalski syndrome

Fluid-attenuated inversion recovery MRI (A). Directionally encoded map with hues reflecting tensor orientation (B). Superimposed images (C, D): a yellow halo represents the infarct and blue lines represent the pyramidal tracts (coronal); the tracts
fuse at the decussation (transverse). Caudal extension of the lesion involves the ipsilateral corticospinal tract (arrows) after
the decussation (arrowheads).

A 66-year-old man developed left hemiparesis, left Horner sign, and sensory loss on his left face and right limbs, without
contralateral hemiparesis or tongue weakness. MRI demonstrated a left lateral-medullary infarction (figure, A). A rare
variant of lateral-medullary syndrome, Opalski syndrome,1 manifests as ipsilateral hemiplegia; however, the anatomic
basis is not established.2 Therefore, we generated a directionally encoded color map (figure, B) using diffusion tensor
imaging techniques and superimposed the images (figure, C and D). These suggest that involvement of the ipsilateral
corticospinal tract after the pyramidal decussation, or compression of the decussation, could cause Opalski syndrome.
Shinichiro Nakamura, MD, Makiko Kitami, MD, Yoshiaki Furukawa, MD, Tokyo, Japan
The authors thank Takashi Tabuchi of the Medical Satellite Yaesu Clinic for technical assistance.
Disclosure: The authors report no disclosures.
Address correspondence and reprint requests to Dr. Shinichiro Nakamura, Department of Neurology, Juntendo Tokyo Koto Geriatric
Medical Center, 3-3-20, Shinsuna, Koto, Tokyo 136-0075, Japan; nakamura@juntendo.gmc.ac.jp
1.
2.

1658

Montaner J, Alvarez-Sabín J. Opalski’s syndrome. J Neurol Neurosurg Psychiatry 1999;67:688 – 689.
Hermann DM, Jung HH, Bassetti CL. Lateral medullary infarct with alternating and dissociated sensorimotor deficits: Opalski’s syndrome revisited. Eur J Neurol 2009;16:e72– e74.

Copyright © 2010 by AAN Enterprises, Inc.