Title: Anaesthetic management for bilateral tubal ligation in patient with opalski syndrome.
Abstract:
Background: Lateral medullary syndrome(Wallenberg's syndrome) is a relatively common
vertebrobasilar vascular syndrome. However, ipsilateral hemiparesis as part of lateral medullary
infarction is rare, and is known as Opalski's syndrome.
AIM: We present the Pre anaesthetic evaluation and anaesthetic management of the patient with
Opalski syndrome posted for tubal ligation in our setting.
Methods: Case characteristics: A 26yr old female with second gravid and parity was scheduled
for bilateral tubal ligation in view of contraception with previous two normal deliveries. She had
history of hypertension during 2nd pregnancy and history of headache, dysarthria, dysphagia,
ataxia, hoarsness of voice and had right side facial weakness with sensory loss on the same side
in the postpartum period around 8months back. With further investigations patient was
diagnosed as atypical postpartum stroke presenting as opalski syndrome.
Results & outcome:This case highlights the rarity of the particular syndrome and careful
preoperative history taking is the key for successful perioperative management and good
postoperative outcome.. Emphasis is to be given on the fact that not all the hypertensives during
pregnancy should be managed as gestational hypertension but also to be evaluated for other
clinical entities. Spinal anaesthesia should not be given in such cases and the case was managed
by giving general anaesthesia.
Conclusion: A good preanesthetic assessment and history taking gave a good perioperative
management is needed for a safe and a satisfactory outcome avoiding complications.