The challenge of basilar artery occlusion wake-up stroke

too late for intravenous thrombolysis?

Pietro Caliandro, Giuseppe Reale, T. Tartaglione, Paolo Maria Rossini

Research output: Contribution to journalArticle

Abstract

We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.

Original languageEnglish
Pages (from-to)1-4
Number of pages4
JournalNeurological Sciences
DOIs
Publication statusAccepted/In press - Mar 10 2016

Fingerprint

Basilar Artery
Stroke
Pons
Dysarthria
Hemiplegia
Consciousness
Hospital Emergency Service
Therapeutics

Keywords

  • Critical care
  • DWI-FLAIR mismatch
  • Stroke
  • Thrombolysis
  • Wake-up stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Psychiatry and Mental health
  • Dermatology

Cite this

The challenge of basilar artery occlusion wake-up stroke : too late for intravenous thrombolysis? / Caliandro, Pietro; Reale, Giuseppe; Tartaglione, T.; Rossini, Paolo Maria.

In: Neurological Sciences, 10.03.2016, p. 1-4.

Research output: Contribution to journalArticle

@article{094abee91295449992a2f55ff52509a5,
title = "The challenge of basilar artery occlusion wake-up stroke: too late for intravenous thrombolysis?",
abstract = "We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 {\%} of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.",
keywords = "Critical care, DWI-FLAIR mismatch, Stroke, Thrombolysis, Wake-up stroke",
author = "Pietro Caliandro and Giuseppe Reale and T. Tartaglione and Rossini, {Paolo Maria}",
year = "2016",
month = "3",
day = "10",
doi = "10.1007/s10072-016-2539-4",
language = "English",
pages = "1--4",
journal = "Neurological Sciences",
issn = "1590-1874",
publisher = "Springer-Verlag Italia s.r.l.",

}

TY - JOUR

T1 - The challenge of basilar artery occlusion wake-up stroke

T2 - too late for intravenous thrombolysis?

AU - Caliandro, Pietro

AU - Reale, Giuseppe

AU - Tartaglione, T.

AU - Rossini, Paolo Maria

PY - 2016/3/10

Y1 - 2016/3/10

N2 - We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.

AB - We describe the case of a patient carried to our emergency department, with the wake-up finding of dysarthria, right hemiplegia and worsening consciousness impairment (NIHSS 12). After performing a CT angiography, which showed complete basilar occlusion, we determined the MR DWI-FLAIR mismatch to estimate the stroke onset time. Because of the favorable mismatch (DWI hyperintensity in the left pons, no FLAIR hyperintensity in the same region), the patient underwent thrombolysis with sudden neurological improvement. In addition, the DWI hyperintensity first observed in the left pons totally regressed after thrombolysis. Wake-up stroke constitutes about 14 % of all strokes, while the percentage of basilar artery occlusion wake-up strokes is still unknown. Although thrombolysis in patients with unknown-onset time is still an off-label therapy, basilar artery occlusion is a potentially fatal event. In our case we used RM DWI-FLAIR mismatch to rapidly estimate the stroke onset time and to treat the patient with an off-label but potentially effective and safe therapy.

KW - Critical care

KW - DWI-FLAIR mismatch

KW - Stroke

KW - Thrombolysis

KW - Wake-up stroke

UR - http://www.scopus.com/inward/record.url?scp=84960447794&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84960447794&partnerID=8YFLogxK

U2 - 10.1007/s10072-016-2539-4

DO - 10.1007/s10072-016-2539-4

M3 - Article

SP - 1

EP - 4

JO - Neurological Sciences

JF - Neurological Sciences

SN - 1590-1874

ER -