To the Editor.
—We read with interest Fisher's description of the "herald hemiparesis" of basilar artery occlusion.1 We were reassured that his experience confirms our observations in three patients who progressed to the locked-in state after presenting with hemimotor and hemisensory symptoms accompanied by marked dysarthria.2 Indeed, as we discussed, several earlier reports of patients who developed this condition due to basilar artery occlusion described a hemiparesis and dysarthria as the presenting symptoms.3-8 In addition, this constellation of findings has been reported to be present in two thirds (10/15) of a sample of patients with brain-stem infarction whose condition subsequently worsened.9We agree that these patients may, at times, be difficult to distinguish from those with hemispheric lesions, and concur that heparin may be a useful treatment if this syndrome is recognized in a timely manner as the harbinger of a potentially grave outcome. Transcranial Doppler
Tuhrim S, Weinberger J. Basilar Artery Occlusion. Arch Neurol. 1989;46(9):946. doi:10.1001/archneur.1989.00520450016007