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Lateral medullary syndrome (LMS) is a neurological disorder usually presenting as loss of pain and thermal sensation over the ipsilateral face and contralateral half of the body, ipsilateral limb ataxia, Horner's syndrome, dysphagia, nystagmus, hiccups among other symptoms but never with limb weakness. In the present case, the patient presented with ipsilateral hemiparesis, which can be attributed to the extension of the infarct caudally beyond the pyramidal decussation, affecting the corticospinal fibers in the upper cervical cord, a variant of LMS, known as Opalski syndrome (OS).

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