Basilar Artery Occlusion Associated With Paradoxical Embolism After Traumatic Spinal Cord Injury: A Case Report.
- 1Department of Critical Care Medicine, Intensive Care Unit, Centenario Hospital Miguel Hidalgo, Aguascalientes, MEX.
Abstract
Basilar artery occlusion is a neurological emergency associated with high mortality and severe disability. In young patients without conventional vascular risk factors, identifying an uncommon embolic mechanism is essential for secondary stroke prevention. We report the case of a previously healthy 21-year-old man who sustained a 6-meter fall resulting in T9-T10 compression fractures with spinal canal compromise and complete traumatic spinal cord injury. He underwent posterior thoracic spinal instrumentation. During hospitalization, he developed sudden neurological deterioration characterized by a generalized tonic-clonic seizure, impaired consciousness, respiratory failure, and hemodynamic instability. Computed tomography angiography demonstrated a partial distal basilar artery occlusion without intracranial hemorrhage. Intravenous thrombolysis was contraindicated because of recent major trauma and spinal surgery. Mechanical thrombectomy using a direct aspiration technique achieved complete reperfusion (thrombolysis in cerebral infarction (TICI) scale 3). Transthoracic echocardiography with agitated saline demonstrated significant right-to-left shunting, with more than 30 microbubbles appearing in the left-sided cardiac chambers from the second cardiac cycle. Subsequent transesophageal echocardiography demonstrated a patent foramen ovale with increased interatrial septal mobility. Although deep venous thrombosis was not documented, the combination of severe spinal cord injury, prolonged immobilization, a prothrombotic state, and a patent foramen ovale with significant right-to-left shunting supported paradoxical embolism as the most plausible mechanism. This case highlights the importance of considering paradoxical embolism in young hospitalized patients who develop posterior circulation stroke following major trauma.
Related
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- Mechanical Thrombectomy of a Combined Persistent Primitive Trigeminal Artery and Basilar Artery Occlusion: A Case Report and Literature Review
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BibTeX
@article{velazquez2026basilar,
title = {{Basilar Artery Occlusion Associated With Paradoxical Embolism After Traumatic Spinal Cord Injury: A Case Report.}},
author = {Ramón Padilla Velázquez and Irving Santiago Fraire Félix and Gustavo Saucedo Sabas and Eliseo Varela Martínez and Edmundo Israel Roque Márquez},
journal = {Cureus},
year = {2026},
month = sep,
doi = {10.7759/cureus.116615},
url = {https://europepmc.org/article/MED/42909170},
note = {CC BY},
}
RIS
TY - JOUR
TI - Basilar Artery Occlusion Associated With Paradoxical Embolism After Traumatic Spinal Cord Injury: A Case Report.
AU - Ramón Padilla Velázquez
AU - Irving Santiago Fraire Félix
AU - Gustavo Saucedo Sabas
AU - Eliseo Varela Martínez
AU - Edmundo Israel Roque Márquez
PY - 2026
DA - 2026/09/20
JO - Cureus
DO - 10.7759/cureus.116615
UR - https://europepmc.org/article/MED/42909170
AB - Basilar artery occlusion is a neurological emergency associated with high mortality and severe disability. In young patients without conventional vascular risk factors, identifying an uncommon embolic mechanism is essential for secondary stroke prevention. We report the case of a previously healthy 21-year-old man who sustained a 6-meter fall resulting in T9-T10 compression fractures with spinal canal compromise and complete traumatic spinal cord injury. He underwent posterior thoracic spinal instrumentation. During hospitalization, he developed sudden neurological deterioration characterized by a generalized tonic-clonic seizure, impaired consciousness, respiratory failure, and hemodynamic instability. Computed tomography angiography demonstrated a partial distal basilar artery occlusion without intracranial hemorrhage. Intravenous thrombolysis was contraindicated because of recent major trauma and spinal surgery. Mechanical thrombectomy using a direct aspiration technique achieved complete reperfusion (thrombolysis in cerebral infarction (TICI) scale 3). Transthoracic echocardiography with agitated saline demonstrated significant right-to-left shunting, with more than 30 microbubbles appearing in the left-sided cardiac chambers from the second cardiac cycle. Subsequent transesophageal echocardiography demonstrated a patent foramen ovale with increased interatrial septal mobility. Although deep venous thrombosis was not documented, the combination of severe spinal cord injury, prolonged immobilization, a prothrombotic state, and a patent foramen ovale with significant right-to-left shunting supported paradoxical embolism as the most plausible mechanism. This case highlights the importance of considering paradoxical embolism in young hospitalized patients who develop posterior circulation stroke following major trauma.
SN - 2168-8184
ER -