Sudden death in a case of lateral medullary syndrome

Abstract

A 39-year-old male,a chronic smoker, presented with vertigo, dysphagia, hoarseness of voice, and imbalance while walking of 6 hours duration. On examination, his blood pressure was 140/90 at admission and the neurological examination revealed sensory loss on the right side of the face and left half of the body with right-sided cerebellar signs, conforming to right LMS. A non contrast computed tomography (CT) scan showed an infarct in the right inferior cerebellum and a CT angiography showed non visualisation of the right vertebral with a thrombus extending into the proximal basilar artery [Figure 1]. The proximal right vertebral artery was well visualised in the CT angiography. Considering the risk of progression to complete basilar artery occlusion, the patient was taken in for an intra-arterial (IA) thrombolysis after full informed consent was obtained. A selective right vertebral artery catherisation was done. A 5 mg bolus of r-tPA was injected over a period of 1 min. This was followed by a slow infusion of 20 mg r-tPA. However, after an infusion of 4 mg of r-tPA after the bolus, the patient had a sudden cardiorespiratory arrest. He succumbed despite resuscitative measures.A non contrast cranial CT scan was repeated, which did not show any hemorrhagic transformation.Recent reportshave described unexpected sudden cardiorespiratory arrest in lateralmedullary infarction during convalescence after a stroke with minimal motor disability.