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Basilar artery stroke in a 69-year-old man

A 69-year-old man with diabetes mellitus, arterial hypertension, and a previous stroke was found unconscious at home. He was last known to be well 8 hours before. His trachea was intubated on the scene by Emergency Medical Services and he was taken to the emergency department. Initial neurologic examination was confounded by residual pharmacologic paralysis and sedation used for intubation. Emergent CT showed a midbasilar hyperdensity suggesting thrombus and MRI demonstrated restricted diffusion in bilateral cerebellar, bilateral thalamic, and bilateral occipital regions. Follow-up examination showed impaired consciousness, bilateral decerebrate posturing, bilateral nonreactive pupillary reflex, bilateral absent corneal reflexes, absent eye movements with oculovestibular reflex testing, and preserved gag reflex. (Contributed by Dr. José Biller.)

Associated Disorders

  • Cortical blindness
  • Dissection
  • Intracranial vertebral artery stroke
  • Locked-in syndrome
  • Top of the basilar syndrome