Neurocritical Care

, Volume 2, Issue 3, pp 296–299

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

Authors

    • The Neurological Intensive Care Unit, Department of NeurologyColumbia University College of Physicians and Surgeons
  • Katja E. Wartenberg
    • The Neurological Intensive Care Unit, Department of NeurologyColumbia University College of Physicians and Surgeons
  • Philip M. Meyers
    • Department of NeurosurgeryColumbia University College of Physicians and Surgeons
    • The Neurological Intensive Care Unit, Department of NeurologyColumbia University College of Physicians and Surgeons
    • Department of NeurosurgeryColumbia University College of Physicians and Surgeons
Practical Pearl

DOI: 10.1385/NCC:2:3:296

Cite this article as:
Janjua, N., Wartenberg, K.E., Meyers, P.M. et al. Neurocrit Care (2005) 2: 296. doi:10.1385/NCC:2:3:296

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

Dissectionvertebral arterybasilar arterythrombolytic therapylocked-in syndromeanticoagulantshypertension

Copyright information

© Humana Press Inc 2005