Case report -Opalski's syndrome A rare variant of lateral medullary syndrome in TAKAYASUS ARTERITIS

We present an interesting case of Opalskis syndrome which is an unusual manifestation of Lateral Medullary Syndrome in addition this patient also has features suggestive of Takayasus arteritis. 42 year female, known diabetic presented with left upper limb claudication and recurrent transient ischemic attacks for the past 3 months, with recent sudden onset of left hemiparesis, left 9th 10th cranial nerve palsy, sensory loss in right half of the body and left half of the face with left cerebellar signs. She had absent pulse in left upper limb and significant BP variation in both upper limbs (BP-right upper limb 11070 mm of Hg, left upper limb not recordable) normal pulse and BP in the lower limbs showing some of the clinical features suggestive of Takayasus arteritis. Her CT scan brain showed left cerebellar infarct, MRI brain revealed acute infarct in left medulla, with rostral spinal cord extension, cerebellar vermis, right occipital lobe, right thalamus, MRA brain was normal, CT Angiogram showed left Subclavian artery occlusion at its origin from the aorta, with faint reformation of distal axillary and brachial artery from the lateral thoracic artery. Patient underwent medical management and improved well and regular follows up.