Presentation
Hemiparesis - rapid progression to collapse, GCS 3 intubated and transferred.
Patient Data
Hyperdense basilar artery extending into PCA.
LVA origin occluded, guide passed, stent and aspiration catheter clot retrieval, angioplasty then stent to ostial disease, finally further thrombectomy and angioplasty of distal C1/2 segment. Good revascularization and reperfusion.
Case Discussion
Diagnosis delayed as presented with unilateral weakness. Progressed while in ED to collapse. A stuttering onset is seen in between 1/3 and 2/3 of case of basilar occlusion. The full hand of altered conscious state, bilateral weakness, and ophthalmaplegia and other brainstem signs do not have to be present to suspect this condition.
Hyperdense basilar artery can be the clue to the diagnosis if not suspected clinically and prompt further imaging.
The bilateral vertebral artery occlusions were not initially recognized as the patient was referred for intracranial clot retrieval - but early recognition allowed appropriate planning of the intervention.