alexa Locked Out: Basilar Dependent Cerebral Circulation in the Setting of Acute Stroke | OMICS International
ISSN: 2329-6895
Journal of Neurological Disorders
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Locked Out: Basilar Dependent Cerebral Circulation in the Setting of Acute Stroke

Kleinman JT, Elahi FM, Ali LK and Hinman JD*
Department of Neurology and Comprehensive Stroke Center, University of California, Los Angeles, USA
Corresponding Author : Jason D. Hinman
David Geffen School of Medicine at UCLA
UCLA Comprehensive Stroke Center
UCLA Neurological Rehabilitation and Research Unit
635 Charles E. Young Dr. South
Neuroscience Research Building, Room 415
Los Angeles, CA 90095, USA
Tel: 310-825-6761
E-mail: [email protected]
Received November 02, 2014; Accepted December 17, 2012; Published December 19, 2012
Citation: Kleinman JT, Elahi FM, Ali LK, Hinman JD (2015) Locked Out: Basilar Dependent Cerebral Circulation in the Setting of Acute Stroke. J Neurol Disord 3: i108. doi: 10.4172/2329-6895.1000i108
Copyright: ©2015 Kleinman JT, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Abstract

A 73 year-old man with past medical history of atrial fibrillation, not on warfarin, severe peripheral vascular disease, coronary artery disease, hypertension, dyslipidemia was speaking with a co-worker and suddenly lost consciousness, dropping to the floor.

Description
A 73 year-old man with past medical history of atrial fibrillation, not on warfarin, severe peripheral vascular disease, coronary artery disease, hypertension, dyslipidemia was speaking with a co-worker and suddenly lost consciousness, dropping to the floor.
He arrived to the emergency department posturing, and he was intubated. Non-contrast head CT demonstrated a probable basilar artery clot (Figure 1A), this was confirmed on CTA, and tPA was administered 31 minutes after arrival and 53 minutes after last-known well.He was taken for angiography. Left (Figure 1B) and right (Figure 1C) common carotid artery injections demonstrated bilateral occlusion of the internal carotid arteries and minimal flow through the sphenopalantine and ethmoidal arteries in a retrograde fashion into the supraclinoid ICAs. The left vertebral artery was dominant, and injection (Figure 1D) demonstrated a tip of the basilar filling defect (arrow), with extension into the right posterior cerebral artery, and minimal cerebral filling. Between the first and second left vertebral artery runs, the posterior circulation recanalized spontaneously (Figure 1E), while tPA was still infusing; 85 minutes post arrival to the emergency department and 107 minutes post symptom onset. Follow up diffusion-weighted imaging obtained 10 hours after onset demonstrated mildly restricted diffusion in the bilateral thalami, with subtle restricted diffusion in the cortex (Figure 1F). Despite revascularization, the patient remained comatose and imaging was obtained at 43 hours post onset for prognostication (Figure 1G). The MRI at that time demonstrated complete sparing of the pons and brainstem. His family opted for comfort measures after discussion with the treating physicians and review of the images. Detailed review of the angiogram indicated the bilateral carotid artery occlusions were chronic, as the left vertebral artery, right posterior communicating artery, and the anterior communicating artery were dilated.

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