Doctor Le Thi Yen Phung, from the Department of Neurology at the Neuroscience Center, Tam Anh General Hospital TP HCM, reported that upon admission, Ms. Nhu was conscious and responsive. Brain magnetic resonance angiography (MRA) results initially showed no occlusion of large brain arteries, with the basilar artery still open. However, the patient had reduced sensation on the left side of her body and was monitored.

Approximately 24 hours later, Ms. Nhu's condition worsened abruptly. She fell into a deep coma, her Glasgow Coma Scale score dropping from 15 to three points, with complete paralysis of all four limbs and poor pupillary light reflexes. At this point, a 3 Tesla MRI of her brain revealed widespread infarction in both sides of the cerebellum, pons, and brainstem, along with complete basilar artery occlusion caused by a blood clot.

Basilar artery occlusion is a severe and dangerous form of ischemic stroke. It can lead to rapid coma and paralysis of all four limbs, often more quickly than other types of stroke, according to Doctor Phung.

Brain MRA upon admission showed no large artery occlusion (left), but after 24 hours, the basilar artery was completely occluded (right). Photo: Tam Anh General Hospital

After a consultation, doctors decided on endovascular intervention for the patient. Digital subtraction angiography (DSA) confirmed complete basilar artery occlusion. Doctors inserted a catheter system from a peripheral artery, guiding it through the vessel to the occlusion in the brain, then used specialized tools to remove the blood clot. This procedure fully restored blood flow through the basilar artery in the brain.

Ms. Nhu has a history of hypertension, type 2 diabetes, ischemic heart disease, and atrial fibrillation, for which she was prescribed anticoagulant medication but took it inconsistently. Doctor Phung explained that atrial fibrillation causes the atrial chambers to contract asynchronously, which can lead to blood stasis and thrombus formation in the heart. Over time, these clots can travel through the bloodstream to the brain, blocking large arteries.

Doctors performed endovascular intervention to remove the blood clot for Ms. Nhu under DSA guidance. Photo: Hospital provided

To reduce the risk of stroke recurrence, Ms. Nhu needs to manage her atrial fibrillation and prevent new thrombus formation. Doctors are monitoring her neurological progression and imaging findings, carefully weighing the risk of hemorrhage before deciding when to restart anticoagulant medication. Administering anticoagulants too soon can increase the risk of bleeding in the damaged brain area, while delaying too long increases the risk of new thrombus formation from the heart and recurrent stroke. After two weeks of treatment, Ms. Nhu showed significant recovery, becoming conscious, mobile, and returning to normal daily activities.

Doctor Phung checking muscle strength after stroke treatment for Ms. Nhu. Photo: Tam Anh General Hospital

Doctor Phung advises that individuals prescribed anticoagulant medication should not stop, reduce the dose, or restart medication without a doctor's guidance.

When stroke symptoms appear, following the BE FAST principle—loss of balance (Balance), vision problems (Eyes), facial drooping (Face), arm weakness or paralysis (Arm), speech difficulty (Speech), and time to call emergency services (Time)—the patient needs immediate transport to a stroke-ready facility. Early detection and intervention can limit brain damage and improve recovery chances.

Trong Nghia

*Patient's name has been changed