Neurocritical Care

, Volume 2, Issue 3, pp 296–299

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

Practical Pearl


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 


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Copyright information

© Humana Press Inc 2005

Authors and Affiliations

  1. 1.The Neurological Intensive Care Unit, Department of NeurologyColumbia University College of Physicians and SurgeonsNew York
  2. 2.Department of NeurosurgeryColumbia University College of Physicians and SurgeonsNew York
  3. 3.Department of Neurology and Neurosciences, Division of Cerebrovascular Disease and Endovascular SurgeryUniversity of Medicine and Dentistry, New JerseyNewark

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