Intra-arterial fibrinolysis in acute thrombosis of the basilar artery
Introduction. Ischemia in the territory of the basilar artery presents with a variable clinical picture of hemiparesiatetraplegia, progressive deterioration of level of consciousness, irregular respiration and apnea leading to irreversible coma and death in between 75% and 86% of cases. The usual treatment is supportive. Clinical case. We present the case of a 49 year old woman with acute thrombosis of the basilar artery and a progressive course leading to coma. No bulbar lesions were seen on the CT scan done in the Emergency Department. Thrombosis of the basilar artery and permeable bilateral carotid systems were shown on arteriography. There were no contra-indications to fibrinolysis. Following local fibrinolytic treatment with urokinase the patient had full recovery from her neurological disorder and no sequelae. The basilar artery remained permeable six months later. Conclusions. Emergency treatment with cerebral intra-arterial fibrinolysis within the first six hours, in a case of neurological deficit progressing in the basilar artery territory, with persistence of brain-stem functions and no signs of decerebration (provided there are no contra-indications to fibrinolysis and the initial cerebral CT scan shows no bulbar lesions) may save the patient’s life, with total or partial recovery of brain-stem function
Caso clínico Presentamos el caso de una mujer 49 años de edad con trombosis aguda de la arteria basilar y evolución progresiva hacia el coma. En la TAC cerebral realizada en Urgencias no se apreciaron lesiones bulbares, demostrándose trombosis de la arteria basilar con permeabilidad de ambos sistemas carotídeos en la angiografía. No existían contraindicaciones para la fibrinólisis. Tras el tratamiento fibrinolítico local con urocinasa, la paciente presentó recuperación completa del cuadro neurológico sin secuelas, y la arteria basilar persistía permeable a los seis meses del tratamiento.
Conclusiones El tratamiento urgente con fibrinólisis intrarterial cerebral dentro de las primeras seis horas, en el caso de déficit neurológico en progresión en el territorio de la arteria basilar, con persistencia de las funciones del tronco y sin signos de descerebración, siempre que no existan contraindicaciones para la fibrinólisis y la TAC cerebral inicial no demuestre lesiones en la zona bulbar, puede salvar la vida del paciente con recuperación total o parcial de las funciones del troncoencéfalo