Basilar artery occlusion after acute myocardial infarction

A 53-year old patient was admitted to the emergency department with acute chest pain, nausea and dyspnea. He had several vascular risk factors such as cigarette smoking, overweight and hypercholesteremia. 12-lead ECG showed ST elevation in the inferior and lateral leads and reciprocal ST depression in the anteroseptal leads indicating acute inferoposterior myocardial infarction. Coronary angiography demonstrated thrombotic occlusion of the proximal left circumflex artery. The occlusion was successfully recanalized by thrombus aspiration and stabilized with an everolimus-eluting stent (Fig. 1). The ventriculography suggested a mild impairment of the left ventricular ejection fraction with profound inferior hypokinesia. Antithrombotic therapy with salicylic acid, clopidogrel and lowmolecular weight heparin was started. Twelve hours later the patient complained of acute headache, vertigo and bilateral hearing loss and minutes later his consciousness decreased. The neurological assessment showed left sided facial palsy, Horner's syndrome and skewdeviation. A detailed sensorimotor assessment of the extremities was impossible due to coma. Intracerebral bleeding was ruled out by computed tomography. The neurologic findings suggested an acute brainstem lesion. The initial NIHSS Score (National Institute of Health Stroke Scale) was assessed to 15 points. The