Introduction: Widespread use of intravenous tissue plasminogen activator (t-PA) for acute ischemic stroke is limited by multiple contraindications
to its use.
Case report: This article describes a patient with stuttering symptoms of pontine ischemia caused by vertebrobasilar dissection who suddenly
deteriorated into a locked-in state 32 hours after symptom onset. The quadriparesis was successfully reversed within 3 hours
of onset with the combination of pharmacologically induced hypertension, anticoagulation, and intravenous t-PA.
Discussion: Even in the face of numerous contraindications (including hypertension, anti-coagulation, and treatment beyond 3 hours of
symptom onset), intravenous t-PA can be used successfully in carefully selected cases.
Key Words Dissection - vertebral artery - basilar artery - thrombolytic therapy - locked-in syndrome - anticoagulants - hypertension