Reversal of locked-in syndrome with anticoagulation, induced hypertension, and intravenous t-PA

Neurocrit Care. 2005;2(3):296-9. doi: 10.1385/NCC:2:3:296.


Introduction: Widespread use of intravenous tissue plasminogen activator (t-PA) for acute ischemic stroke is limited by multiple contraindications to its use.

Case report: This article describes a patient with stuttering symptoms of pontine ischemia caused by vertebrobasilar dissection who suddenly deteriorated into a locked-in state 32 hours after symptom onset. The quadriparesis was successfully reversed within 3 hours of onset with the combination of pharmacologically induced hypertension, anticoagulation, and intravenous t-PA.

Discussion: Even in the face of numerous contraindications (including hypertension, anticoagulation, and treatment beyond 3 hours of symptom onset), intravenous t-PA can be used successfully in carefully selected cases.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Anticoagulants / therapeutic use
  • Drug Administration Schedule
  • Humans
  • Infusions, Intravenous
  • Male
  • Plasminogen Activators / administration & dosage*
  • Quadriplegia / drug therapy*
  • Quadriplegia / etiology
  • Tissue Plasminogen Activator / administration & dosage*
  • Vasoconstrictor Agents / therapeutic use
  • Vertebral Artery Dissection / complications


  • Anticoagulants
  • Vasoconstrictor Agents
  • Plasminogen Activators
  • Tissue Plasminogen Activator