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

Kuster, Gustavo Wruck; Baruzzi, Antonio Claudio; Ikeoka, Dimas; Pieruccetti, Marco; Furlan, Valter

doi:10.1590/0004-282X20130208

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 ¹ ^- ³ , IV thrombolysis was performed and maybe prevented microembolic events, improving prognosis ⁴ ^, ⁵ .

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

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