Male, 58yrs, presented to the emergency department within 4 hours of developing stupor, dysphasia, and left hemiplegia.
DWI showed bilateral paramedian thalamic infarction (Fig1) although LVO in posterior circulation was not recorded in MRA and DSA (Fig 2,3).
DSA: Microcatheter was approached near top of basilar artery and infused intra-arterial alteplase (IA) with only dose 2 ml / 15 minutes. Fig 4 after showed appearance of many braches of paramedian arteries [Fig 4: before (left) - after (right)].
Patient was fully recovered 24 hours after the intervention, without limb weakness on physical examination.
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Fig 4:
DWI showed bilateral paramedian thalamic infarction (Fig1) although LVO in posterior circulation was not recorded in MRA and DSA (Fig 2,3).
DSA: Microcatheter was approached near top of basilar artery and infused intra-arterial alteplase (IA) with only dose 2 ml / 15 minutes. Fig 4 after showed appearance of many braches of paramedian arteries [Fig 4: before (left) - after (right)].
Patient was fully recovered 24 hours after the intervention, without limb weakness on physical examination.
Fig 1:
Fig 2:
Fig 3:
Fig 4: