title: Reversal of locked-in syndrome with anticoagulation, induced hypertension, and intravenous t-PA.
abstract: 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.
authors.affiliation: The Neurological Intensive Care Unit, Department of Neurology, Columbia University College of Physicians and Surgeons, New York, NY, USA. janjuana@umdnj.edu
authors.forename: Nazli
authors.initials: N
authors.lastname: Janjua
authors.forename: Katja E
authors.initials: KE
authors.lastname: Wartenberg
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.forename: Stephan A
authors.initials: SA
authors.lastname: Mayer
mesh_terms: 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
chemical_list: D000925:Anticoagulants; D014662:Vasoconstrictor Agents; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator