Reversal of locked-in syndrome with anticoagulation, induced hypertension, and intravenous t-PA.
BACKGROUND
Widespread use of intravenous tissue plasminogen activator (t-PA) for acute ischemic stroke is limited by multiple contraindications to its use.


METHODS
This article describes a patient with stuttering symptoms of pontine ischemia caused by vertebrobasilar dissection who suddenly deteriorated into a locked-in state 32 hours after symptom onset. The quadriparesis was successfully reversed within 3 hours of onset with the combination of pharmacologically induced hypertension, anticoagulation, and intravenous t-PA.


CONCLUSIONS
Even in the face of numerous contraindications (including hypertension, anticoagulation, and treatment beyond 3 hours of symptom onset), intravenous t-PA can be used successfully in carefully selected cases.
Janjua
Nazli
N
The Neurological Intensive Care Unit, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA. janjuana@umdnj.edu
Wartenberg
Katja E
KE
Meyers
Philip M
PM
Mayer
Stephan A
SA
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D004334:Drug Administration Schedule; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D010960:Plasminogen Activators / Q000008:administration & dosage*; D011782:Quadriplegia / Q000188:drug therapy* / Q000209:etiology; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014662:Vasoconstrictor Agents / Q000627:therapeutic use; D020217:Vertebral Artery Dissection / Q000150:complications
D000925:Anticoagulants; D014662:Vasoconstrictor Agents; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator