Reversibility of brainstem damage after a mechanical thrombectomy.

Diffusion-weighted imaging(DWI)has revealed the reversal ofoften sizeable damage due to brainstem lesions in patients treated within 4.5 hours, and this reversibility of damage was strongly associated with early neurological improvement.1 In posterior circulation stroke, the reversibility of damage due to aDWI-detected lesion ispoorlydocumentedafter intravenous thrombolysis2 or intraarterial therapy.3,4 We report a case of vertebrobasilar stroke mechanically recanalized 4.5 hours after symptom onset that revealed substantial reversal of early ischemic damage to the brainstem on DWI scans. A51-year-oldman suddenlywent into comaafter experiencing bilateral flaccidity in the lower extremities. A noncontrast computed tomographic scan showed that there were no signs of cerebral ischemia. Magnetic resonance imaging of the brain was performed 3 hours after onset, and DWI scans showed right lateral pontine (Figure, A) and central pontine infarction (Figure, B) secondary to acute basilar artery occlusion (Figure, C). A mechanical thrombectomy using a Solitaire Flow Restoration (FR) stent (Covidien)was performedwhile the patientwas under general anesthesia, andcomplete recanalizationwasobtained4.5hoursafter stroke onset (Figure, D). The patientwas extubated 12 hours later, and recoverywas complete on day 1.Magnetic resonance imaging onday 4 revealed total reversibility of the damage to the right lateral portion of the pons due to the lesion (Figure, E) and significant reduction inthevolumeofthecentralportionof thepons(Figure,G).These findingswere also observed in fluid-attenuated inversion recovery sequences (Figure, F-H).