From tip to tpa

We present the case of a 50 year old lady who presented with sudden onset altered sensorium, anarthria, right hemianopia, ophthalmoplegia, quadriparesis and abnormal posturing of upper limbs for 4 hours. The NIHSS score was 31. The CT brain showed early ischemic changes in left posterior cerebral artery territory. The CT cerebral angiogram showed occlusion of the tip of basilar artery. Intravenous thrombolysis with rtPA resulted in remarkable recovery and NIHSS improved to 3 within 6 hours. In view of expected severe disability associated with tip of basilar artery syndrome, intravenous thrombolysis can be rewarding even in patients with high NIHSS