2024 American Academy of Neurology Abstract Website

Objective:

To describe a rare case of Opalski Syndrome associated with Short-lasting Unilateral Neuralgiform headaches with Conjunctival injection and Tearing (SUNCT) features.

Background:

Lateral Medullary Syndrome (LMS) is a common presentation of posterior circulation stroke, and different clinical variations have been documented. Opalski Syndrome is a rare LMS presentation with ipsilateral hemiparesis due to ischemia compromising the corticospinal tract caudal to the pyramidal decussation. SUNCT is a trigeminal cephalalgia that can be found in patients with posterior fossa structural abnormalities. Secondary SUNCT syndrome can be rarely caused by dorsolateral medullary infarction. It likely presents post-injury and irritation of the trigeminal and hypothalamospinal tracts, which could lead to aberrant activation of the trigeminovascular system. However, the complete pathophysiological mechanism remains unknown.

Design/Methods:

A 41-year-old male with a past medical history of obesity was brought to the hospital due to vertigo and imbalance that started three days prior to admission. Examination showed Right Horner’s syndrome, bilateral multidirectional nystagmus, decreased temperature and pain sensation in the right hemiface and left hemibody, ataxic gait, and right-sided hemiparesis. On succeeding days, he presented brief headache episodes accompanied by tearing and redness of the right eye.

Results:

Brain-CT was unremarkable, head and neck CTA showed bilateral calcification of the vertebral arteries. Brain-MRI revealed subacute ischemic infarction of the right dorsolateral medulla with anterior-caudal extension. MRA of the head and neck exhibited right posterior inferior cerebellar artery occlusion. Stroke workup was performed; coagulopathy and cardioembolic sources were ruled out. Etiology remained undetermined. Antiplatelet and statin therapy were initiated while commencing physical therapy.

Conclusions:

Opalski Syndrome is a rare presentation of LMS infrequently associated with SUNCT-like manifestations. Here, we present an unusual case highlighting how presentations may vary according to the involvement of particular areas of the dorsolateral medulla.