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Current Drug Safety

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ISSN (Print): 1574-8863
ISSN (Online): 2212-3911

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Case Report

Safety of Intravenous Thrombolysis and Mechanical Thrombectomy in Bilateral Posterior Cerebral Artery Territory Infarction

Author(s): Maurizio Acampa*, Francesca Guideri, Sandra Bracco, Rossana Tassi, Carlo Domenichelli, Pietro Enea Lazzerini, Samuele Cioni and Giuseppe Martini

Volume 17, Issue 3, 2022

Published on: 13 January, 2022

Page: [274 - 278] Pages: 5

DOI: 10.2174/1574886316666211008140212

Price: $65

Abstract

Background: Acute bilateral blindness is an uncommon phenomenon that requires immediate diagnosis and action. The emergent evaluation should concentrate on an early distinction between ocular, cortical, and psychogenic etiologies.

Objective: To present a case of cortical blindness without anosognosia due to the embolic occlusion of both posterior cerebral arteries (PCAs) and treated by intravenous and mechanical thrombolysis.

Case Report: A 67-year-old woman was admitted to the Stroke Unit due to cortical blindness without anosognosia. At the admission to the hospital, an emergent computed tomography scan of the brain ruled out intracranial acute hemorrhage and showed subtle changes consistent with hyperacute ischemia of the left occipital cortex, while a CT angiography demonstrated the occlusion of the P3 segment of both right and left posterior cerebral arteries. The patient was treated with combined thrombolysis (intravenous and mechanical thrombolysis), obtaining complete revascularization and a significant clinical improvement.

Conclusion: Even if there is no randomized controlled trial to compare the effectiveness and safety of mechanical thrombectomy (MT) to intravenous thrombolysis in patients with posterior circulation occlusion, the good outcome of this case encourages combined stroke treatments in posterior circulation stroke, even in case of mild but disabling neurological deficits.

Keywords: Cortical blindness, posterior cerebral artery, alteplase, mechanical thrombolysis, Penumbra 4Max, stent retriever, case report.

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Graphical Abstract

[1]
Pula JH, Yuen CA. Eyes and stroke: the visual aspects of cerebrovascular disease. Stroke Vasc Neurol 2017; 2(4): 210-20.
[http://dx.doi.org/10.1136/svn-2017-000079] [PMID: 29507782]
[2]
Lazzarino De Lorenzo LG, Ffytche DH, Di Camillo E, Buiatti T. The Dide-Botcazo syndrome: forgotten and misunderstood. Cortex 2014; 56: 182-90.
[http://dx.doi.org/10.1016/j.cortex.2013.01.011] [PMID: 23473855]
[3]
Kakaletsis N, Tziomalos K, Spilioti M, et al. Bilateral cortical blindness due to bilateral occipital infarcts without Anosognosia. J Neurol Stroke 2016; 4(1): 00120.
[http://dx.doi.org/10.15406/jnsk.2016.04.00120]
[4]
Nouh A, Remke J, Ruland S. Ischemic posterior circulation stroke: a review of anatomy, clinical presentations, diagnosis, and current management. Front Neurol 2014; 5: 30.
[http://dx.doi.org/10.3389/fneur.2014.00030] [PMID: 24778625]
[5]
Cereda C, Carrera E. Posterior cerebral artery territory infarctions. In: Paciaroni M, Agnelli G, Caso V, Bogousslavsky J, Eds. Manifestations of stroke. Basel: Karger 2012; Vol. 30: pp. 128-31.
[http://dx.doi.org/10.1159/000333610]
[6]
Seners P, Perrin C, Lapergue B, et al. Bridging therapy or IV thrombolysis in minor stroke with large vessel occlusion. Ann Neurol 2020; 88(1): 160-9.
[http://dx.doi.org/10.1002/ana.25756] [PMID: 32350929]
[7]
Wang F, Wang J, He Q, et al. Mechanical thrombectomy for posterior circulation occlusion: A comparison of outcomes with the anterior circulation occlusion - A meta-analysis. J Atheroscler Thromb 2020; 27(12): 1325-39.
[http://dx.doi.org/10.5551/jat.54221] [PMID: 32062629]
[8]
Meyer L, Stracke CP, Jungi N, et al. Thrombectomy for primary distal posterior cerebral artery occlusion stroke: The TOPMOST study. JAMA Neurol 2021; 78(4): 434-44.
[http://dx.doi.org/10.1001/jamaneurol.2021.0001] [PMID: 33616642]
[9]
Cappellari M, Tomelleri G, Di Matteo A, et al. Dide-Botcazo syndrome due to bilateral occlusion of posterior cerebral artery. Neurol Sci 2010; 31(1): 99-101.
[http://dx.doi.org/10.1007/s10072-009-0179-7] [PMID: 19924506]
[10]
Leone G, Nappini S, Wlderk A, et al. Resolution of Anton-Babinski syndrome after systemic thrombolysis and mechanical thrombectomy with a stentriever. J Clin Neurosci 2018; 48: 111-4.
[http://dx.doi.org/10.1016/j.jocn.2017.10.053] [PMID: 29122459]

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