А favorable outcome of comprehensive treatment of a patient with locked-in syndrome due to post-traumatic vertebra-basilar artery occlusion
Резюме. One of the most devastating consequences of vertebrobasilar artery occlusion is locked-in syndrome, and is most often associated with unfavorable clinical outcomes. Traumatic vertebrobasilar artery occlusion is increasingly recognized as a common cause of stroke in young patients. There is a growing body of evidence that early diagnosis and comprehensive differential treatment of this condition in early stage of ischemic neurologic event can lead to improved outcome. Identification and treatment of these injuries prior to the development of irreversible cerebral ischemia should be priority and demand a high degree of vigilance in patients with high-risk mechanism and injury patterns. Intracranial angioplasty stenting may be an efficient and life-saving procedure in patients with vertebra-basilar artery occlusion in addition to traditional pharmacological recanalization thrombolysis techniques. The objective of this case study is to describe and discuss the clinical management and outcome of a 34-year-old previously healthy female who developed a locked-in syndrome following a traumatic vertebral artery dissection. Case study. Patient underwent emergency stent assisted angioplasty of the vertebrobasilar arteries following antiplatelet/anticoagulation therapy to reperfuse the affected region. Computer tomography, magnetic-resonance imaging/magnetic-resonance angiography and angiography studies were used during initial evaluation and treatment. Rehabilitation program was initiated immediately following surgery. Results. Eighteen months after the accident she was able to ambulate independently without gait aids, using an ankle-foot orthotic only for long distance ambulation. She lives independently in an apartment, continues to be active, well motivated and plans to return to work in the near future. Сonclusions. Intracranial angioplasty stenting may be an efficient and life saving procedure in patients with vertebra-basilar artery occlusion in addition to traditional pharmacological recanalization thrombolysis techniques. This case illustrated a perfect combination of early diagnostic and surgical intervention followed by complex, multifaceted, intensive rehabilitation treatment, which led to significant recovery and excellent long term neurological outcome.