A 65-year-old man with a history of Wallenberg syndrome caused by vertebral artery dissection at 62 years old was admitted to our hospital with nausea, vertigo, right facial dysesthesia, right hemiplegia, crossed sensory disturbance (sensory loss and numbness in the right face and left body below the neck), and right limb ataxia. Magnetic resonance imaging (MRI) performed 80 minutes after onset revealed no acute ischemic stroke lesions, but magnetic resonance angiography (MRA) demonstrated complete occlusion of the right vertebral artery. Based on these neurological and MRA findings, atypical lateral medullary infarction was suggested, and intravenous tissue plasminogen activator (IV-tPA) was started 178 minutes after onset. Right hemiplegia improved immediately after IV-tPA administration. MRI performed on hospital day 2 showed an acute ischemic lesion on the right side of the medulla oblongata, resulting in a diagnosis of Opalski syndrome. Opalski syndrome is a rare subtype of Wallenberg syndrome accompanied by hemiplegia of the side ipsilateral to the lesion, and expansion of the stroke lesion to the corticospinal tract below the pyramidal decussation is considered to cause ipsilateral hemiplegia. Based on this case and previous reports, Opalski syndrome should be considered when limb ataxia and crossed sensory deficit are observed among patients with hyperacute-onset hemiplegia, and IV t-PA therapy should be considered even in the absence of neurological findings such as dysphagia, dysarthria, and Horner's signs and radiological evidence of acute ischemic stroke.

中文翻译：

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静脉重组组织型纤溶酶原激活物治疗Opalski综合征的病例报告和文献复习。

一名因62岁的椎动脉夹层引起的Wallenberg综合征病史的65岁男子因恶心，眩晕，右面部感觉异常，右半身不遂，交叉感觉障碍（右侧感觉丧失和麻木）入院面部和左半身低于颈部），以及右肢共济失调。发病后80分钟进行磁共振成像（MRI），未发现急性缺血性中风病变，但磁共振血管造影（MRA）显示右椎动脉完全闭塞。根据这些神经学和MRA的发现，提示非典型性外侧延髓梗塞，并在发病后178分钟开始静脉注射组织纤溶酶原激活剂（IV-tPA）。IV-tPA给药后右偏瘫得到改善。在医院第2天进行的MRI检查显示，延髓右侧有急性缺血性病变，可诊断出Opalski综合征。Opalski综合征是Wallenberg综合征的罕见亚型，伴有病变侧同侧偏瘫，并且将中风病灶扩展至锥体束下方的皮质脊髓束被认为会导致同侧偏瘫。根据该病例和以前的报道，当在超急性发作性偏瘫患者中观察到肢体共济失调和交叉感觉障碍时，应考虑Opalski综合征，即使在没有神经系统症状如吞咽困难，构音障碍，霍纳氏体征和急性缺血性中风的影像学证据。导致诊断为Opalski综合征。Opalski综合征是Wallenberg综合征的罕见亚型，伴有病变侧同侧偏瘫，并且将中风病灶扩展至锥体束下方的皮质脊髓束被认为会导致同侧偏瘫。根据该病例和以前的报道，当在超急性发作性偏瘫患者中观察到肢体共济失调和交叉感觉障碍时，应考虑Opalski综合征，即使在没有神经系统症状如吞咽困难，构音障碍，霍纳氏体征和急性缺血性中风的影像学证据。导致诊断为Opalski综合征。Opalski综合征是Wallenberg综合征的罕见亚型，伴有病变侧同侧偏瘫，并且将中风病灶扩展至锥体束下方的皮质脊髓束被认为会导致同侧偏瘫。根据该病例和以前的报道，当在超急性发作性偏瘫患者中观察到肢体共济失调和交叉感觉障碍时，应考虑Opalski综合征，即使在没有神经系统症状如吞咽困难，构音障碍，霍纳氏体征和急性缺血性中风的影像学证据。脑卒中病灶扩展到锥体束下方的皮质脊髓束被认为引起同侧偏瘫。根据该病例和以前的报道，当在超急性发作性偏瘫患者中观察到肢体共济失调和交叉感觉障碍时，应考虑Opalski综合征，即使在没有神经系统症状如吞咽困难，构音障碍，霍纳氏体征和急性缺血性中风的影像学证据。脑卒中病灶扩展到锥体束下方的皮质脊髓束被认为引起同侧偏瘫。根据该病例和以前的报道，当在超急性发作性偏瘫患者中观察到肢体共济失调和交叉感觉障碍时，应考虑Opalski综合征，即使在没有神经系统症状如吞咽困难，构音障碍，霍纳氏体征和急性缺血性中风的影像学证据。