Basilar artery occlusion presenting as refractory status epilepticus

Abstract

Seizures secondary to brainstem stroke are rare and only few case reports are available in literature. Only one case of status epilepticus has been reported in the brainstem stroke. We report in best of our knowledge the first case of refractory status epilepticus in the brainstem stroke and review the relevant literature. We present a case of 45-year-old hypothyroid female presented with loss of consciousness followed by generalized tonic-clonic seizures which turned out into refractory status epilepticus as benzodiazepines and antiepileptic drugs were ineffective. Magnetic resonance imaging and angiography of brain revealed basilar artery occlusion with infarcts of midbrain, bilateral thalami and cerebellum without cortical involvement. Emergency physician should be aware of this unusual presentation of brainstem stroke as timely intervention for stroke can improve the outcome.