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

Abstract

SummaryThe 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.

Locked-In Syndrome after Trauma—A Rare Case in the Literature

“…4 Vertebral artery dissections (VADs) correspond to 20% of cases of cerebral infarction in patients under 45 years and LIS is the most feared complication, occurring in 10 to 15% of basilar artery occlusions (BAOs). 3,10,11 BAO is a serious condition that presents with 90% mortality in the first 4 months. 3,10 VADs are divided into spontaneous or traumatic, the latter being more common in young patients, younger than 45 years.…”

“…3,10,11 BAO is a serious condition that presents with 90% mortality in the first 4 months. 3,10 VADs are divided into spontaneous or traumatic, the latter being more common in young patients, younger than 45 years. 8,12 The incidence of traumatic lesion of the vertebral arteries varies on the literature, but may affect 0.5 to 2% of all polytraumatized patients and up to 20% of those with cervicocranial trauma.…”

“…Physical therapy for the control of secretions is critical for the disease, especially in the first 4 months of hospital stay, as well as pulmonary hygiene and respiratory pattern monitoring. 1,10,17 When respiratory problems are detected, early ventilatory support should be considered. In addition, consciousness is preserved, so it would be important to develop a definitive form of communication, an aim to avoid confusion and frustration for the patient, due to constant changes in the means of communication.…”