'Herald hemiparesis' of basilar artery occlusion: early recognition by transcranial Doppler ultrasound

The acute cerebrovascular event: surgical and other interventional therapies

Over the next decade, more early and aggressive treatments will become available for acute stroke. As EPs have been forced to push their skills and knowledge significantly further with the advent of time-sensitive interventions for myocardial ischemia, a similar sophistication will undoubtedly emerge in the management of acute stroke. Certain components of the neurological examination will likely assume a new significance and, as with the renewed focus on the nature of ST segment change on the ECG in ACS, there will be new attention to early imaging findings in stroke. Although it is unclear whether the balance of future advances in treatment will come from the world of neurosurgery, neurology, or interventional radiology, the EP is relatively assured to play a central role in their implementation.

Basilar artery thrombosis

Basilar artery thrombosis is an infrequent but important neurological emergency requiring early diagnosis and treatment. Of particular relevance to emergency medicine is the recognition and consideration of the unusual signs that may be present in an often previously well patient. It is therefore crucial to expedite investigations, confirm the diagnosis and commence life-saving treatment through the early involvement of a number of disciplines including neurology, radiology and intensive care. This paper confirms the use of magnetic resonance imaging and angiography as the preferred investigative mode and microcatheter directed intra-arterial thrombolysis as the treatment strategy of choice.