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Images in Neurology • Arq. Neuro-Psiquiatr. 72 (1) • Jan 2014 • https://doi.org/10.1590/0004-282X20130208   copy

Intravenous thrombolisys in basilar dissection: report of a good recovery and follow-up

Trombólise endovenosa em dissecção de artéria basilar: relato de boa recuperação e seguimento

Authorship SCIMAGO INSTITUTIONS RANKINGS

A 33 year-old man arrived after 3h with dysarthria and right-sided hemiparesis (National Institutes Health Stroke Scale (NIHSS:11)). We perform IV thrombolysis and after 1h, NIHSS: 4. After 24h, he presented fluctuating neurological symptoms. Angiography and CT-angio (CTA) (Figures A and B) demonstrated an isolated dissection of the basilar artery, without subarachnoid hemorrhage. Anticoagulation was initiated with rapid improvement. After 7 days he was discharged with NIHSS: 2, Rankin: 2. CTA (Figure C) showed partial basilar recanalization, and after 6 months (Figure D) the basilar artery was normal. Although not considered a formal therapeutic option for arterial dissection 11 . Caplan LR: Dissection of brain-supplying arteries. Nat Clin Pract Neurol 2008;4:34-42.

2 . Kim BM, Suh SH, Park SI, et al. Management and clinical outcome of acute basilar artery dissection. Am J Neuroradiol 2008;29:1937-1941. - 33 . Tognola WA, Centola Filho CA, Chueire RHFM. Dissecção da artéria basilar: relato de caso. Arq Neuropsiquiatr 2000;58:356-359 , IV thrombolysis was performed and maybe prevented microembolic events, improving prognosis 44 . Droste DW, Junker K, Stogbauer F, et al. Clinically silent circulating microemboli in 20 patients with carotid and vertebral artery dissection. Cerebrovasc Dis 2001;12:181-185. , 55 . Ruecker M, Furtner M, Knoflach M, et al. Basilar artery dissection: series of 12 consecutive cases and review of the literature: Cerebrovasc Dis 2010;30:267-276. .

Figure.
A) Basilar artery dissection without vertebral artery involvement in Digital Subtraction Angiography – lateral image (arrow). B) CT-angio: Isolated narrowing of basilar artery in day 1 (arrowhead). C) Partial recanalization of basilar artery lumen in day 7 (arrowhead). D) After six months, basilar artery without pseudoaneurysm and improvement of recanalization (arrowhead).

References

  • 1
    Caplan LR: Dissection of brain-supplying arteries. Nat Clin Pract Neurol 2008;4:34-42.
  • 2
    Kim BM, Suh SH, Park SI, et al. Management and clinical outcome of acute basilar artery dissection. Am J Neuroradiol 2008;29:1937-1941.
  • 3
    Tognola WA, Centola Filho CA, Chueire RHFM. Dissecção da artéria basilar: relato de caso. Arq Neuropsiquiatr 2000;58:356-359
  • 4
    Droste DW, Junker K, Stogbauer F, et al. Clinically silent circulating microemboli in 20 patients with carotid and vertebral artery dissection. Cerebrovasc Dis 2001;12:181-185.
  • 5
    Ruecker M, Furtner M, Knoflach M, et al. Basilar artery dissection: series of 12 consecutive cases and review of the literature: Cerebrovasc Dis 2010;30:267-276.

Publication Dates

  • Publication in this collection
    Jan 2014

History

  • Received
    20 May 2013
  • Reviewed
    22 July 2013
  • Accepted
    29 July 2013
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