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Abstract Details

Re-perfusing the pediatric Basilar Artery Occlusion: Extended-window Mechanical Thrombectomy!
Cerebrovascular Disease and Interventional Neurology
Cerebrovascular Disease and Interventional Neurology Posters (7:00 AM-5:00 PM)
047

To describe a pediatric case of acute non-traumatic basilar artery occlusion/stroke (BAO/BAS) recanalized via extended-window mechanical thrombectomy (MT). 
In the pediatric population, BAO is very rare but can be potentially fatal and may cause severe disability. Early recognition of BAO is imperative as intravenous thrombolysis or MT can aid in salvaging the ischemic brainstem. MT is an emerging therapy in the adult acute BAO, but its role in children is not well established. In this report, we describe a case of BAO/BAS in a 14-year-old boy recanalized via MT in the extended time window (>24 hours from symptom onset) and had a favorable outcome. 
NA 
A 14-year-old boy  presented from an outside hospital with altered sensorium and emesis lasting 12 hours. He had a 3-week history of asthenia and intermittent gait instability. His initial pediatric NIH Stroke Scale (NIHSS) was scored at a minimum of 19 (2 each for the level of consciousness, questions, commands, motor drifts in arms, legs, dysarthria; 3 for aphasia) and intact extra-ocular movements. Computed tomography angiography of head & neck showed a proximal - mid basilar artery occlusion while a magnetic resonance imaging (MRI) brain scan at the transferring hospital suggested acute bilateral pontine infarcts. Therefore, we pursued MT with thrombolysis in cerebral infarction (TICI) grade improving from 0 to 3. At 72 hours, repeat NIHSS had improved to 10 (3 for bifacial weakness, 1 each for drifts in arms, legs, dysarthria; 2 for limb ataxia) with MRI brain showing acute bilateral pontine and cerebellar infarcts. He was eventually discharged to an inpatient rehabilitation for ataxia and was able to ambulate independently after a week of therapy. 

Early neuro-interventional therapy for pediatric BAO can result in excellent clinical outcomes despite severe neurological deficits and a prolonged period from symptom onset to clinical diagnosis. 

 
Authors/Disclosures
Bismah Arif Hasan
PRESENTER 		Ms. Hasan has nothing to disclose.
Nujud Farag, MD (Wake Forest University) Dr. Farag has nothing to disclose.
Vandana J. Vedanarayanan, MD (UMMC) Dr. Vedanarayanan has nothing to disclose.
Shashank Shekhar, MBBS The institution of Dr. Shekhar has received research support from Sponsor Department of Health and Human Services. The institution of Dr. Shekhar has received research support from PockitDx.
Shreyas Gangadhara, MD, FÂ鶹´«Ã½Ó³»­ (University of Mississippi Medical Center) Dr. Gangadhara has nothing to disclose.
No disclosure on file
John B. Ingram, MD (University of Mississippi Medical Center) Dr. Ingram has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for UCB. Dr. Ingram has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Eisai.
Christa O'hana S. Nobleza, MD Dr. Nobleza has nothing to disclose.
Prashant Natteru, MBBS (Mayo Clinic Health System) Dr. Natteru has nothing to disclose.