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

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.

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.