Practical Pearl

Neurocritical Care

, Volume 2, Issue 3, pp 296-299

First online:

Reversal of locked-in syndrome with anticoagulation, induced hypertension, and intravenous t-PA

  • Nazli JanjuaAffiliated withThe Neurological Intensive Care Unit, Department of Neurology, Columbia University College of Physicians and Surgeons Email author 
  • , Katja E. WartenbergAffiliated withThe Neurological Intensive Care Unit, Department of Neurology, Columbia University College of Physicians and Surgeons
  • , Philip M. MeyersAffiliated withDepartment of Neurosurgery, Columbia University College of Physicians and Surgeons
  • , Stephan A. MayerAffiliated withThe Neurological Intensive Care Unit, Department of Neurology, Columbia University College of Physicians and SurgeonsDepartment of Neurosurgery, Columbia University College of Physicians and Surgeons Email author 

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Abstract

Introduction: Widespread use of intravenous tissue plasminogen activator (t-PA) for acute ischemic stroke is limited by multiple contraindications to its use.

Case report: This article describes a patient with stuttering symptoms of pontine ischemia caused by vertebrobasilar dissection who suddenly deteriorated into a locked-in state 32 hours after symptom onset. The quadriparesis was successfully reversed within 3 hours of onset with the combination of pharmacologically induced hypertension, anticoagulation, and intravenous t-PA.

Discussion: Even in the face of numerous contraindications (including hypertension, anti-coagulation, and treatment beyond 3 hours of symptom onset), intravenous t-PA can be used successfully in carefully selected cases.

Key Words

Dissection vertebral artery basilar artery thrombolytic therapy locked-in syndrome anticoagulants hypertension