Neurorehabilitation in basilar artery occlusion in a young patient with thrombophilia and antiphospholipid antibody syndrome – a case report

Abstract

Twenty percent of strokes occurring in young patients are represented by posterior ischemic strokes. Acute basilar occlusion is a devastating, life-threatening condition, with the highest mortality in young patients. We present the case of a 33-year-old female patient, without vascular risk factors or oral contraceptive treatment, admitted to our department through the emergency ward for comatose state -Glasgow Coma Scale (GCS) 11 points, headaches, right-sided hemiparesis, dizziness and vomiting, with acute onset. CT angiography was performed, which showed left vertebral artery with no flow in the intradural section and absent flow in the basilar artery. After more than 12 hours from onset, endarterectomy was excluded; initiation of treatment with heparin 1000 IU/hour was decided. MRI performed after 24 hours revealed: subacute median and left paramedian pontine ischemic stroke, subacute stroke in the base of the left midbrain peduncle. The following diagnosis was established: pontine ischemic stroke caused by two autoimmune diseases: thrombophilia and antiphospholipid antibody syndrome. Our patient started rehabilitation very early and was discharged with the following neurological sequelae: tetraparesis with the predominance of left hemiparesis: 4/5 on the Medical Research Council strength scale (MRC) -right limbs, 3/5 on the Medical Research Council strength scale (MRC) -left limbs, and dysphagia for liquids.

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