22. European Stroke Conference 642 Acute stroke: emergency management, stroke units and complications Reversible `Locked-In Syndrome` after Basilar Artery Dissection A.C. Kruetzelmann1, M. Rosenkranz2, C. Gerloff3, J. Fiehler4, C. Brekenfeld5 Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany, Ham-burg, GERMANY1, Department of Neurology, University Medical Center Hamburg-Eppendorf, Germany, Hamburg, GERMANY2, Department of Neurology, University Medical Center Ham-burg- Eppendorf, Germany, Hamburg, GERMANY3, Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany, Hamburg, GERMANY4, Department of Neurora-diology, University Medical Center Hamburg-Eppendorf, Germany, Hamburg, GERMANY5 Background: Acute basilar artery (BA) dissections are associated with high mortality rates. Early recanalization by endovascular treatment might improve outcome. Methods: A 29 year old man presented to the ER with acute tetraplegia, respiratory impairment and complete horizontal gaze palsy, i.e. a locked-in syndrome. The day before he had developed neck pain, nausea, and vomiting after intensive wrestling training. Acute stroke MRI showed distinct diffusion restriction within the entire cross-section of the pons. TOF-MRA revealed a BA occlu-sion. Iv-thrombolysis with rt-PA was initiated immediately and the patient was transferred to the angio-suite for additional mechanical recanalization. Angiography confirmed BA occlusion and me-chanical thrombectomy was successfully performed using a Solitaire-Stent. However, control angio-gram after 20 minutes revealed a subtotal re-occlusion. Additionally, vessel wall irregularities were noted. Therefore the Solitaire-Stent was inserted again and finally detached permanently resulting in a complete recanalization of the BA. Results: MRI the day after showed discrete edema of the pons but no infarct demarcation on T2- and FLAIR-weighted images. Neurological sequelae had completely resolved. Conclusion: Dissections are a rare cause of BA occlusions. The case demonstrates that distinct ADC-alterations within the brain stem may completely resolve and are not always associated with a severe prognosis. Therefore a targeted endovascular treatment should not be excluded. 686 © 2013 S. Karger AG, Basel Scientific Programme 643 Acute stroke: emergency management, stroke units and complications Venous hypertension as the etiology of intracranial hemorrhagic complication during endovas-cular therapy of stroke F. Tsai1, K.-W. Lee2, C.-J. Chen3, C. Chen4 Imaging Research Center/Taipei Medical University, Taipei, TAIWAN1, TMU/Chang Hua Christian Hospital, Chang Hua, TAIWAN2, Taipei Medical University, Taipei, TAIWAN3, TaiChung Veterans General Hospital, Taichung, TAIWAN4 Endovascular procedures have been widely used to restore cerebral circulation for stroke. Cerebral circulation is usually stable even with increasing cerebral blood flow after restoration of ce-rebral circulation. However, hyper-perfusion may develop in some occasions(1-6).Intracranial hem-orrhagic complication is rare from hyper-perfusion and the etiology is not certain and no reliable data(5-10). We had observed that intracranial hemorrhage may be relating impairment of venous drainage. Materials and Methods: We have retrospectively reviewed 317 consecutive patients from January of 3009 to December of 2010. 54 of those patients had received endovascular procedures to treat ischemic stroke. Male to fe-male ratio is 30 to 24 and age range from 15 to 89 with average 56.2 years. Endovascular procedures are stenting and thrombolysis for stroke. Results: Among those 54 patients,14 of those patients suffered various degree of complications of hyper-per-fusion from stroke therapy with stenting and/or thrombolysis. 14 those patients had abnormal ve-nous drainage; 8 of those 14 those patients had various hemorrhagic complication after procedure with hypoplasia of ipsilateral transverse sinus,6 of those fatal hemorrhagic complications had atresia of ipsilateral transverse sinus. 2 of 8 stroke patients had after procedure mild hemorrhage with hypo-plasia of dural sinus but no atresia.
Karger_ESC London_2013
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