Title:Safety of Intravenous Thrombolysis and Mechanical Thrombectomy in
Bilateral Posterior Cerebral Artery Territory Infarction
Volume: 17
Issue: 3
Author(s): Maurizio Acampa*, Francesca Guideri, Sandra Bracco, Rossana Tassi, Carlo Domenichelli, Pietro Enea Lazzerini, Samuele Cioni and Giuseppe Martini
Affiliation:
- Department of Emergency-Urgency and Transplants, Azienda Ospedaliera Universitaria Senese, “Santa Maria alle
Scotte” General-Hospital, Siena, Italy
Keywords:
Cortical blindness, posterior cerebral artery, alteplase, mechanical thrombolysis, Penumbra 4Max, stent retriever, case report.
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.
