https://doi.org/10.4081/ecj.2024.12602
From locked-in sensation to acute basilar artery occlusion: a rare case of posterior circulation stroke in a young patient
Submitted: 24 April 2024
Accepted: 13 June 2024
Published: 18 July 2024
Accepted: 13 June 2024
Abstract Views: 399
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
We report the case of a young male patient who presented to our emergency department complaining of a transient headache and a feeling of motor impairment in his right lower limb, both of which completely resolved spontaneously. After a few minutes of his arrival, he developed a locked-in sensation with anxiety and agitation, followed by a rapid onset of left facio-brachio-crural hemisyndrome. Contrast-enhanced CT of the brain and neck showed the occlusion of the proximal-intermediate basilar artery. Acute basilar artery occlusion (BAO) is a rare life-threatening stroke that requires prompt diagnosis and appropriate treatment to avoid rapid fatal complications (coma and death). The prognosis is poor, with long-lasting sequelae in the survivors. The diagnosis is often difficult since BAO accounts for only 1% of all strokes, and the prodromal symptoms are often very mild, transient, and non-specific, such as nausea, dizziness, headache, confusion, and vertigo. In the presence of convulsion-like symptoms or an unexplained altered level of consciousness, emergency physicians should always consider BAO in the differential diagnosis.
Mattle HP, Arnold M, Lindsberg PJ, et al. Basilar artery occlusion. Lancet Neurol 2011;10:1002-14.
DOI: https://doi.org/10.1016/S1474-4422(11)70229-0
Rai AT, Seldon AE, Boo S, et al. A population-based incidence of acute large vessel occlusions and thrombectomy eligible patients indicates significant potential for growth of endovascular stroke therapy in the USA. J Neurointerv Surg 2017;9:722-6.
DOI: https://doi.org/10.1136/neurintsurg-2016-012515
Schonewille WJ, Wijman CA, Michel P, et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): a prospective registry study. Lancet Neurol 2009;8:724-30.
DOI: https://doi.org/10.1016/S1474-4422(09)70173-5
Kompanje EJ, Walgaard C, de Groot YJ, Stevens M. Historical sources of basilar artery occlusion. Neurology 2011;76:1520-3.
DOI: https://doi.org/10.1212/WNL.0b013e318217e755
Voetsch B, DeWitt LD, Pessin MS, Caplan LR. Basilar artery occlusive disease in the New England Medical Center Posterior Circulation Registry. Arch Neurol 2004;61:496-504.
DOI: https://doi.org/10.1001/archneur.61.4.496
Bacchi S, Tan S, Goh R, et al. Basilar artery occlusion presenting with reduced level of consciousness: a diagnosis not to miss. Intern Emerg Med 2023;18:933-36.
DOI: https://doi.org/10.1007/s11739-023-03212-z
Conte WL, Gill CE, Biller J. Top of the basilar syndrome presenting with convulsions. JAMA Neurol 2017;74:248-9.
DOI: https://doi.org/10.1001/jamaneurol.2016.3449
Inui R, Fujiwara S, Kuroda T, et al. Convulsive-like symptoms as initial indications of basilar artery occlusion: A case series study. eNeurologicalSci 2022;28:100410.
DOI: https://doi.org/10.1016/j.ensci.2022.100410
Ikram A, Zafar A. Basilar artery infarct. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551854/
Gómez-Martí M, Boschín V, Puchades F, et al. Ictus isquémico por oclusión de la arteria basilar en una paciente puérpera con infección por SARS-CoV-2 [Ischaemic stroke due to basilar artery occlusion in a puerperal patient with SARS-CoV-2 infection]. Rev Neurol 2022;75:97-100. Spanish.
DOI: https://doi.org/10.33588/rn.7504.2021373
Tsuchiya T, Koizumi S, Tomioka A, et al. Acute ischemic stroke due to basilar artery occlusion with coronavirus disease 2019: a case report. NMC Case Rep J 2021;8:579-85.
DOI: https://doi.org/10.2176/nmccrj.cr.2021-0043
Zhang W, Xing W, Gu H, He J. Acute pontine infarction in a patient with 8-shaped basilar artery fenestration malformation: A case report. Medicine (Baltimore) 2022;101:e29445.
DOI: https://doi.org/10.1097/MD.0000000000029445
Aoki T, Kuwayama K, Kobata H, et al. Endovascular mechanical thrombectomy for basilar artery occlusion caused by thrombosis as an initial manifestation of acute myelogenous leukemia: a case report. NMC Case Rep J 2021;8:767-72.
DOI: https://doi.org/10.2176/nmccrj.cr.2021-0212
Deshpande GG, Riffle RM, Meagher S. Basilar artery stroke in Crohn's disease treated with endovascular thromboembolectomy. BMJ Case Rep 2022;15:e244652.
DOI: https://doi.org/10.1136/bcr-2021-244652
New PF, Aronow S. Attenuation measurements of whole blood and blood fractions in computed tomography. Radiology 1976;121:635-40.
DOI: https://doi.org/10.1148/121.3.635
Connell L, Koerte IK, Laubender RP, et al. Hyperdense basilar artery sign-a reliable sign of basilar artery occlusion. Neuroradiology 2012;54:321-7.
DOI: https://doi.org/10.1007/s00234-011-0887-6
Gory B, Mazighi M, Labreuche J, et al. Predictors for mortality after mechanical thrombectomy of acute basilar artery occlusion. Cerebrovasc Dis 2018;45:61-7.
DOI: https://doi.org/10.1159/000486690
Alemseged F, Nguyen TN, Alverne FM, et al. Endovascular therapy for basilar artery occlusion. Stroke 2023;54:1127-37.
DOI: https://doi.org/10.1161/STROKEAHA.122.040807
Goyal N, Tsivgoulis G, Nickele C, et al. Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion. J Neurointerv Surg 2016;8:783-6.
DOI: https://doi.org/10.1136/neurintsurg-2015-011883
Vergouwen MD, Compter A, Tanne D, et al. Outcomes of basilar artery occlusion in patients aged 75 years or older in the Basilar Artery International Cooperation Study. J Neurol 2012;259:2341-6.
DOI: https://doi.org/10.1007/s00415-012-6498-2
Arnold M, Fischer U, Compter A, et al. Acute basilar artery occlusion in the Basilar Artery International Cooperation Study: does gender matter? Stroke 2010;41:2693-6.
DOI: https://doi.org/10.1161/STROKEAHA.110.594036
Maus V, Kalkan A, Kabbasch C, et al. Mechanical thrombectomy in basilar artery occlusion: presence of bilateral posterior communicating arteries is a predictor of favorable clinical outcome. Clin Neuroradiol 2019;29:153-60. Erratum in: Clin Neuroradiol. 2018 Jan 9.
DOI: https://doi.org/10.1007/s00062-017-0651-3
Compter A, van der Hoeven EJ, van der Worp HB, et al. Vertebral artery stenosis in the Basilar Artery International Cooperation Study (BASICS): prevalence and outcome. J Neurol 2015;262:410-7.
DOI: https://doi.org/10.1007/s00415-014-7583-5
Diprose WK, Diprose JP, Tarr GP, et al. Vertebrobasilar artery calcification and outcomes in posterior circulation large vessel occlusion thrombectomy. Stroke 2020;51:1301-4.
DOI: https://doi.org/10.1161/STROKEAHA.119.027958
Pallesen LP, Gerber J, Dzialowski I, et al. Diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT in the basilar artery international cooperation study. J Neuroimaging 2015;25:384-9.
DOI: https://doi.org/10.1111/jon.12130
How to Cite
Poggiali, E., Morelli, N., Terracciano, C., Caborni, C., Pergolotti, B., Gavioli, P., & Vercelli, A. (2024). From locked-in sensation to acute basilar artery occlusion: a rare case of posterior circulation stroke in a young patient. Emergency Care Journal, 20(3). https://doi.org/10.4081/ecj.2024.12602
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