An Unhappy Patient following Successful Sonothrombolysis in Vertebrobasilar Thrombosis: Dilemma with Final Diagnosis

Acute vertebrobasilar thrombosis is often associated with high mortality and prolonged disability. Therapeutic route and the time window for systemic thrombolysis in acute settings remain uncertain. We describe a case of severe acute ischemic stroke due to vertebrobasilar thrombosis who achieved rapid arterial recanalization and remarkable clinical recovery during ultrasound enhanced intravenous thrombolysis, initiated at 4.5 hours after the symptom-onset. We discuss some important issues, related to the final diagnosis, that arise due to the complete clinical recovery, rapid arterial recanalization and absence of any acute infarction on subsequent neuroimaging.