Recurrent Lateral Medullary Infarction with Ipsilateral Motor and Sensory Deficits and a Delayed Worsening of Crossed Hypoalgesia and Thermohypoesthesia: A Case Report.

The clinical course of early recurrent lateral medullary infarction (LMI) is unclear. We describe the case of an 83-year-old man with severe vertebral artery atherosclerosis who developed early recurrent right LMI. He had ipsilateral Horner's syndrome, bulbar symptoms, and ipsilateral motor-sensory deficits (an Opalski syndrome-like presentation). Imaging revealed caudal extension of the lesion toward the paramedian cervicomedullary junction. A gradual improvement was observed with dual antiplatelet therapy and argatroban hydrate. Contralateral hypoalgesia and thermohypoesthesia were initially minimal, became prominent after 1 week, and later improved spontaneously. Delayed sensory changes during recurrent LMI may complicate the clinical interpretation, warranting careful serial neurological and radiological assessments.