Locked in and out: a case of emerging basilar artery obstruction secondary to vertebral artery dissection thrombolysed with intravenous rt-PA

• Published in: BMJ case reports Vol. 2011; no. may10 1; p. bcr1220103584
• Main Authors: Al-Raweshidy, Y H, Sinha, D M, Coward, L J, Guyler, P C, O’Brien, A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 12-05-2011; BMJ Publishing Group
• Series: Reminder of important clinical lesson
• Subjects: Adult; Aspirin; Brain Stem Infarctions - diagnosis; Brain Stem Infarctions - etiology; Dissection; Dysarthria; Europe (West); Fibrinolytic Agents - therapeutic use; Humans; Ischemia; Male; Patients; Quadriplegia - prevention & control; Reminder of Important Clinical Lesson; Stroke; Thrombolytic Therapy - methods; Tissue Plasminogen Activator - therapeutic use; Veins & arteries; Vertebral Artery Dissection - complications; Vertebral Artery Dissection - diagnosis; Vertebrobasilar Insufficiency - diagnosis; Vertebrobasilar Insufficiency - drug therapy; Vertebrobasilar Insufficiency - etiology; White
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.12.2010.3584

The authors present a case in which intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) potentially saved a young man from locked-in syndrome or life threatening consequences. The patient presented with acute stroke secondary to vertebral artery dissection and was treated with intravenous rt-PA. There were no post thrombolysis complications and the patient left hospital with mild neurological symptoms. Our report suggests that in cases of acute posterior circulation stroke due to arterial dissection, treatment with intravenous thrombolysis is safe, practicable and effective.