Abstract Details

Title Basilar Artery Occlusion With Reverse Locked-in Syndrome

Topic Neuro-ophthalmology/Neuro-otology

Presentation(s) P4 - Poster Session 4 (8:00 AM-9:00 AM)

Poster/Presentation
Number 17-010

Objective We present a case illustrating a “reverse locked-in syndrome,” characterized by persistent almost total ophthalmoplegia with a normal motor exam following basilar artery thrombectomy.

Background First coined by Raibakgar et al, the term “reverse locked-in syndrome” described an uncommon presentation associated with endovascular recanalization of the top of the basilar artery. Basilar artery occlusions are classically associated with locked-in syndrome, wherein the patient is quadriplegic with horizontal gaze palsies but retains vertical eye movements.

Design/Methods An 87-year-old male presented with acute-onset coma and mid-basilar occlusion. On arrival, he exhibited forced eye closure, global aphasia, and movement of all extremities in the plane of the bed. Despite non-compliance with outpatient rivaroxaban and thrombolysis not being considered, he underwent thrombectomy achieving TICI 3 recanalization. Postprocedural neurological exams and imaging, including MRI and CT angiogram, were performed to evaluate brain infarction and vascular status.

Results Post-thrombectomy, the patient demonstrated midline gaze with complete ophthalmoplegia in all directions but was able to follow commands and lift all extremities without drift. MRI revealed symmetric acute medial bithalamic and biventral tegmentum midbrain infarcts suggestive of Percheron territory infarction, though the artery of Percheron was not visualized. Five days after the procedure, the patient showed improved mentation, verbal output, and strength (at least 4/5 in all extremities), but remained ophthalmoplegic except for minimal leftward gaze; rightward, upward, and downward gaze remained plegic with absent oculocephalic reflex.

Conclusions This case highlights a rare presentation of “reverse locked-in syndrome” after basilar artery thrombectomy, characterized by near-complete ophthalmoplegia despite preserved motor function, contrasting the classical locked-in syndrome phenotype.

Authors/Disclosures
Floyd Silva, MD PRESENTER	Dr. Silva has nothing to disclose.
Lea Saab	Miss Saab has nothing to disclose.
Nicole Zougheib, DO, MBA (Rowan-Virtua SOM)	Dr. Zougheib has nothing to disclose.
Daniella Iglesias Hernández, MD (NYU Langone Brooklyn)	Dr. Iglesias Hernández has nothing to disclose.
Jennifer A. Frontera, MD (NYU Langone Health)	Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving as a Consultant for FirstKindMedical. Dr. Frontera has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Physician ��ɫ�� Resource. The institution of Dr. Frontera has received research support from NIH. The institution of Dr. Frontera has received research support from Alexion. Dr. Frontera has received publishing royalties from a publication relating to health care.
Ting Zhou, MD (New York University Langone Health - Brooklyn)	Dr. Zhou has nothing to disclose.

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