A 40-year-old male patient, without cardiovascular risk factors, right-handed, modified Rankin scale 0 (mRs) consulted at his base hospital for insidious occipital headache associated with gait disturbance.
She was hospitalized and a brain computed tomography (CAT) study was performed, which was interpreted without lesions.
She presented with transient ischemic attack. Doppler ultrasound of the carotid arteries showed no findings and was discharged.
The patient persisted with moderate headache and 3 days after discharge he suffered a new picture of nausea and vomiting associated with left hemiparesis, so he consulted the emergency service.
A new CT scan was performed, which showed no signs of ischemia or hemorrhage, but with doubtful signs of right hypodensity.
Therefore, she was hospitalized in the ICU of her basic hospital with a diagnosis of ischemic stroke of the middle cerebral artery.
He developed fever in regular conditions, dysphagia, respiratory distress and was treated with broad-spectrum antibiotics.
Magnetic resonance imaging (MRI) of the brain was requested to complement the study, so the patient was admitted to the Hospital Clínico Universidad Católica (HCUC) directly to the Critical Patient Unit.
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The patient was hemodynamically stable, with 4 h of previous neurological symptoms.
The patient was evaluated by the neurology team, highlighting one case of hypersomnia, with simple orders, with horizontal to left nystagmus and hemiparesis with left brachio-crural scale of stroke (FBC)
Brain MRI showed left cerebellar infarction in territories of superior cerebellar artery (SUCA), inferior posterior cerebellar artery (PICA) and bilateral bridge infarction.
It was complemented with NMR angiography which showed basilar trunk occlusion and right vertebral artery dissection.
The patient had neurological symptoms after progression of left neurological deficit and was admitted right hemiparesis for which it was decided to perform cerebral angiography and his findings underwent mechanical thrombolysis with SolitUC FR®, 2 h.
During the procedure, a thrombus was detected in the distal third of the basilary artery, which was completely reperfused with the passage of the device on three occasions by the affected area.
Anticoagulation was initiated with heparin in continuous infusion pump and antiplatelet therapy with aspirin.
Control CT showed hemorrhagic transformation of the infarction of the SUCA territory. Aspirin was discontinued and maintained with neuroprotection measures without new neurological deficits.
The patient was discharged from the hospital with a satisfactory left-sided facial-crural paresis, with extreme left nystagmus, minimal to right paresis, left brachial plejia and proximal crural NIHSS muscle contracture.
