title: Skew deviation: a precursor to basilar artery thrombosis.
abstract: The aim of this study was to describe skew deviation and vertical nystagmus as the initial signs for basilar artery thrombosis, a life-threatening disease. A 51-year-old woman complained of vertical diplopia for more than 20 h. A computed tomography of the brain was normal, but subsequently the patient developed additional symptoms including nausea, ventilation problems (dyspnoea) and somnolence. Neuro-ophthalmological evaluation revealed a skew deviation and a vertical nystagmus. Magnetic resonance imaging allowed the diagnosis of basilar artery occlusion. An emergency intervention with cerebral catheter angiography and local intra-arterial thrombolysis was performed. Total recanalization of the basilar artery was achieved resulting in a complete neurological recovery, including the skew deviation and nystagmus. This rare case of skew deviation associated with basilar artery occlusion was a diagnostic challenge and highlights adequate differential diagnosis. Skew deviation is an important clinical sign. In this patient it was the key to a correct diagnosis enabling an immediate and successful intervention.
authors.forename: Stefan
authors.initials: S
authors.lastname: Mennel
authors.forename: Klaus
authors.initials: K
authors.lastname: Hergan
authors.forename: Silvia
authors.initials: S
authors.lastname: Peter
mesh_terms: D002533:Cerebral Angiography; D004172:Diplopia / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009759:Nystagmus, Pathologic / Q000175:diagnosis* / Q000188:drug therapy; D013285:Strabismus / Q000175:diagnosis* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator