Abstract
A 67-year-old man was admitted to our hospital due to a sudden onset of unconsciousness and right hemiparesis. Acute basilar artery occlusion was suspected due to his clinical symptoms and the presence of atrial fibrillation on ECG. His brain CT scan demonstrated no abnormal findings 1 hr after the onset. The rapid improvement in consciousness and motor function, in addition to no occlusion and stenosis in major intra-cranial arteries on a 3D-CT angiography, suggested very early spontaneous recanalization of occluded vessels, and therefore, thrombolytic therapy was not indicated. Although he looked neurologically intact thereafter on the day of admission, he complained of blindness on the next day. He was diagnosed with cortical blindness because of acute bilateral posterior cerebral artery infarction on his brain MRI. The patient, on the day of admission, appeared to manifest Anton’s syndrome, a form of anosognosia in which patients do not realize their blindness. To take advantage of t-PA, prompt and precise evaluation of neurological symptoms needs to be done in all cases of acute cerebral infarctions. The current case is an example of the pit falls in diagnosing acute cerebral infarctions, and suggests the necessity of evaluating NIHSS even in cases in which early spontaneous recanalization of occluded vessels shows improvement of neurological symptoms and thrombolytic therapy is not indicated.
