Status Epilepticus Due To Basilar Artery Occlusion

Öz

We present this case to highlight the rapid and effective multidisciplinary intervention involving emergency medicine, neurology, cardiology, and radiology departments for a young patient initially brought to the emergency department with suspected head trauma, who was later diagnosed with status epilepticus. A 42-year-old male patient experienced syncope on the street, followed by a generalized tonic-clonic seizure lasting about one to two minutes. Bystanders called an ambulance. The patient had a known diagnosis of atrial fibrillation and had a pacemaker implanted three years ago. Brain CTA showed embolic occlusion extending from the proximal to the apex of the basilar artery. With a preliminary diagnosis of status epilepticus, neurology and anesthesia clinics were consulted. Due to basilar artery occlusion, interventional radiology was contacted, and thrombectomy was planned. The patient was transferred to the neurology ward with a GCS of 15 and no neurological sequelae. Basilar artery occlusion (BAO) accounts for about 10% of large vessel occlusion (LVO) strokes. It is associated with higher morbidity and mortality compared to anterior circulation strokes, with a mortality rate of ≥40% Early diagnosis is lifesaving due to the ambiguous course of symptoms and high mortality. The goal is to reduce mortality with the help of an experienced neuroradiologist and comprehensive diagnostic and therapeutic approaches.

Anahtar Kelimeler

• emergency medicine
• thrombectomy
• stroke

Kaynakça

1. 1. Drumm, B.; Banerjee, S.; Qureshi, M.M.; Schonewille, W.J.; Klein, P.; Huo, X.; Chen, Y.; Strbian, D.; Fischer, U.; Puetz, V.; et al. Current Opinions on Optimal Management of Basilar Artery Occlusion: After the BEST of BASICS Survey. Stroke Vasc. Interv. Neurol. 2022, 2, e000538.
2. 2. Schonewille, W.J.; Wijman, C.A.C.; Michel, P.; Rueckert, C.M.; Weimar, C.; Mattle, H.P.; Engelter, S.T.; Tanne, D.; Muir, K.W.; Molina, C.A.; et al. Treatment and outcomes of acute basilar artery occlusion in the Basilar Artery International Cooperation Study (BASICS): A prospective registry study. Lancet Neurol. 2009, 8, 724–730.
3. 3. Abdalkader, M.; Finitsis, S.; Li, C.; Hu, W.; Liu, X.; Ji, X.; Huo, X.; Alemseged, F.; Qiu, Z.; Strbian, D.; et al. Endovascular versus Medical Management of Acute Basilar Artery Occlusion: A Systematic Review and Meta-Analysis of the Randomized Controlled Trials. J. Stroke 2023, 25, 81–91.
4. 4. Haussen, D.C.; Al-Bayati, A.R.; Mohammaden, M.H.; Sheth, S.A.; Salazar-Marioni, S.; Linfante, I.; Dabus, G.; Starosciak, A.K.; Hassan, A.E.; Tekle, W.G.; et al. The Society of Vascular and Interventional Neurology (SVIN) Mechanical Thrombectomy Registry: Methods and Primary Results. Stroke: Vascular and Interventional Neurology. Am. Heart Assoc. 2022, 2, e000234.