This paper is a case report of a 22 year old, previously healthy woman that presented comatose to the Emergency Room at Landspitali University Hospital Iceland. A CT image of the head on admission revealed a large right cerebellar infarct with oedema compressing the fourth ventricle. A CT angiogram on admission was suspicious for a dissection of the left vertebral artery (confirmed during endovascular treatment) and a total occlusion of the distal third of the basilar artery. Thrombolytic therapy with t-PA was initiated followed by thrombectomy with good recanalization. The following day the patient underwent suboccipital craniotomy for malignant cerebellar infarction. She made a good clinical recovery to a modified Ranking scale of 1 at 90 days after discharge from the hospital. Following the case is a literature review on the clinical aspects of occlusion of the vertebrobasilar system, use and utility of imaging and treatment with (anticoagulation, IV and IA thrombolysis) modalities that have been tried. Finally, the evidence regarding thrombectomy and the role of craniotomy for malignant stroke are reviewed.
Keywords: IV and IA thrombolysis; anticoagulation; Telemedicine and Craniotomy for malignant stroke; Vertebrobasilar occlusion; angiogram; information from an prospective open trial; thrombectomy.