Exceptional Rehabilitation Outcome of an 18 Year Old with Basilar Artery Occlusion

Case Diagnosis: Patient is an 18 year old male presenting to the hospital with basilar artery occlusion who subsequently underwent emergent mechanical thrombectomy with significant functional improvement while in IPR.

Case Description: Patient is an 18-year-old male presenting to the ED after being found unconscious. On arrival, NIHSS was 27. Patient could blink to command and had fixed downward gaze. CTA of the brain showed a proximal basilar artery occlusion. Patient underwent thrombectomy with revascularization of the left vertebral artery and basilar artery. Post thrombectomy, patient had rapid return of function beginning with spontaneous movement of all extremities. Patient subsequently was transferred to IPR.

Discussion: Basilar artery occlusions (BAO) account for 1% of all strokes and are associated with poor outcomes and high likelihood of chronic disability even with successful recanalization. The American Stroke Association concluded that initial NIHSS score of < 15, distal basilar artery occlusion, and good collateral circulation are all predictors of positive clinical outcome post mechanical thrombectomy in patients with BAO. This case illustrates an unlikely positive clinical outcome given patient’s clinical presentation and can likely be attributed to patient’s existing collateral circulation and young age.

Setting: Inpatient Rehabilitation

Assessment/Results: Patient presented to IPR with improving quadriparesis, aphonia, and absent gag reflex. All other cranial nerves were intact. Laryngoscopy illustrated bilateral true vocal cord adductor paresis; however, during his IPR course, patient began phonating and repeat laryngoscopy showed bilateral true vocal folds with symmetric full ROM. During outpatient rehabilitation follow-up, patient had full recovery of cranial nerves and sensorimotor deficits. Patient continues to follow with SLP for his dysphonia.

Conclusion: This case report presents a rare presentation of a BAO in an 18-year-old male with rapid improvement of major functional deficits. Traditional functional thresholds for admission to IPR might be greatly liberalized in young patients who inherently have a stronger probability of significant recovery.