A man in his 60s presented with impaired level of alertness, convulsive-like movements of the limbs, and vertical nystagmus. Initial imaging findings were consistent with top of the basilar artery occlusion (Figure 1). He received intravenous tissue plasminogen activator and was brought for an attempted endovascular intervention. Thrombectomy was not successful owing to a tortuous vertebral artery, although there was already partial recanalization of the basilar artery from the intravenous tissue plasminogen activator. Subsequent magnetic resonance imaging showed bilateral occipital-temporal, thalamic, and cerebellar hemispheric infarctions (Figure 2). In the hospital, he was found to have paroxysmal atrial fibrillation. At the end of his hospitalization, he had a left visual field deficit, left hemibody weakness, and left hemibody ataxia. His weakness improved during rehabilitation. Convulsive-like activity can be an initial presentation of an impending basilar artery occlusion.1,2
Conte WL, Gill CE, Biller J. Top of the Basilar Syndrome Presenting With Convulsions. JAMA Neurol. 2017;74(2):248–249. doi:10.1001/jamaneurol.2016.3449
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