B48-41 Missed Case of Basilar Artery Stroke Diagnosis, Morbidity and Mortality Case

Abstract Intro Basilar artery occlusion often carries a grave prognosis, particularly because diagnosis is often delayed, or even missed, as a result of nonspecific and nonfocal symptoms. We present a case of a male patient with a basilar stroke that was initially missed then re-presented. Case A 46-year old male with hypertension, hyperlipidemia, and tobacco use presented to the emergency department (ED) for right-sided weakness, facial droop, and dysarthria. He had previously presented 1-week prior for similar symptoms, endorsing disorientation, shaking, dizziness, and unsteadiness at home, was worked up for benign paroxysmal positional vertigo and discharged home. On repeat ED visit, his NIHSS was 19; workup revealed basilar artery occlusion. He underwent emergent mechanical thrombectomy by neurosurgery with TICI-3 revascularization of the basilar artery. He initially improved then was noted to have seizure-like activity. CTA showed re-occlusion of the basilar artery, and the patient underwent repeat mechanical thrombectomy, angioplasty, and stent placement. MRI brain following day showed multiple acute infarcts. Status-post stent, patient was started on Aggrestat, but was stopped for a period of time, before being restarted due to a delayed order. The patient was continued on anticoagulation and received a stroke workup. He continued to experience weakness on his right side, encephalopathy, and underwent trach/PEG placement. He responded to verbal stimulation, but was not able to ambulate or coordinate movements on own. He was discharged to rehab and continued on physical and occupational therapy. Discussion Basilar artery strokes are often misdiagnosed due to a lack of specific, focal symptoms, oftentimes presenting with complaints like dizziness, vertigo, nausea, or altered mental status, which is mistaken for other etiologies, such as benign positional vertigo, epilepsy, vestibular disorder, or hypoglycemia. Early detection is crucial for effective treatment. Due to the misdiagnosis, it can lead to increased rates of mortality and disability, especially in low and middle income countries. Our patient would have benefited from CTA and further imaging at his initial visit. There was a period of time where the patient should have been on Aggrestat, an antiplatelet medication, in the setting of a fresh stent placement but was not. This alerts to another need for awareness on importance of anticoagulation in setting of new stent placement amongst physician, nursing, and staff; identifying root cause and analysis, and extra caution in patients with unexplained neurologic symptoms and nonspecific signs of strokes in the posterior circulation. This abstract is funded by: None