[Locked-in syndrome due to a vertebral dissection and therapeutic options with intraarterial fibrinolysis in acute phase].
BACKGROUND
Dissection of vertebral artery is an unusual pathology but sometimes is the cause of stroke in young patients. Since last years, and with the rise of some chiropractic technics, some authors have related these ones with the dissection of vertebral artery.


METHODS
We show a case of a 37 years old woman that after a chiropractic session began symptoms of posterior circulation dysfunction as decrease level of sense, tetraparesis and alteration of cranial nerves. The arteriography confirmed the existence of a vertebral dissection of V2 portion and thrombosis of basilar and contralateral vertebral arteries. Intraarterial fibrinolysis was performed with complete recanalization of the artery. Although this, the patient had parenchimal lesions in pons, cerebellum and territory of posterior cerebral artery that produced a locked-in syndrome. All the complementary exams were normal.


CONCLUSIONS
We discuss the relationship between cervical manipulation as an aetiology of vertebral dissection, locked-in syndrome and therapeutic options in these patients
Izquierdo-Casas
J
J
Servicio de Neurología, Hospital General de Catalunya, Sant Cugat del Vallès, Barcelona, Spain. jizquierdo@hgc.es
Soler-Singla
L
L
Vivas-Díaz
E
E
Balaguer-Martínez
E
E
Sola-Martínez
T
T
Guimaraens-Martínez
L
L
D000328:Adult; D002545:Brain Ischemia / Q000209:etiology / Q000473:pathology; D002574:Cervical Vertebrae; D005260:Female; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D026882:Manipulation, Chiropractic / Q000009:adverse effects*; D011782:Quadriplegia / Q000209:etiology* / Q000473:pathology; D013577:Syndrome; D020217:Vertebral Artery Dissection / Q000150:complications / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000209:etiology / Q000473:pathology
D005343:Fibrinolytic Agents