Opalski Syndrome:

Opalski Syndrome (OS) is an unusual presentation ofLateral Medullary Syndrome (LMS) with ipsilateral hemiparesis.We report the case of a 65-year-old woman with a backgroundof unprovoked deep venous thrombosis and unintentionalweight loss that presented after a one-week-long episode ofsudden onset vertigo, frontotemporal headache, blurry vision,and weakness. A head magnetic resonance imaging (MRI)revealed subacute ischemic event, with flow-void loss in theright vertebral artery and absence of blood flow, suggesting OSsecondary to likely right posterior inferior cerebellar artery(PICA) occlusion. An abdominal and thoracic computedtomography (CT) scan showed suggestive findings of stage IVpancreatic tail cancer. Because of its non-classical presentation,OS might be a diagnostic challenge to most physicians. As inthis patient, the existence of concomitant cancer probably led toa hypercoagulable state, which could explain the ischemicstroke while on anticoagulation therapy.