[A quickly reversible occlusion in the vertebrobasilar circulatory bed: often unrecognized?]

A 29-year-old man presented in another hospital because of discoordination of all extremities with sudden onset. After fast reversal of the symptoms, he was discharged without a clear diagnosis. Because of remaining discrete dysarthria, computed tomography and magnetic resonance imaging were performed which demonstrated bilateral cerebellar infarcts. The cause was assumed to be a transient embolic occlusion of the distal basilar artery.

Intravenous heparin was started to prevent further occlusions. Because no source for emboli or other causes were found, the patient was discharged after 14 days on acetylic acid (250 mg/d) as secondary prevention therapy.

A vascular or neurological cause is often not considered when neurological symptoms are quickly reversible after a transient occlusion of the basilar artery. In these cases, the suspected diagnoses of psychiatric illness, alcohol abuse, drug intoxication, infection or myocardial infarction do not lead to the necessary investigations. Thus, a potentially life-threatening situation may be disregarded.