Bilateral Oculomotor Nerve Palsy: A Rare Complication of Bridging Thrombolysis for Acute Basilar Artery Occlusion.

Abstract

Acute vertebrobasilar artery occlusion (AVBAO) accounts for only 1-2% of ischemic stroke, but it has high disability and mortality rates. Mechanical thrombectomy (MT) combined with intravenous thrombolysis can quickly achieve vascular recanalization and significantly improve patient prognosis. This report describes a 73-year-old male who was admitted to the hospital in a coma due to AVBAO. After MT, successful recanalization of the basilar artery was achieved; however, the patient subsequently developed the rare but serious complication of bilateral oculomotor nerve palsy. The report emphasizes the need for careful preoperative planning, including detailed assessment of vascular anatomy and thrombus characteristics, and the importance of operator expertise. Improved intraoperative technique and close postoperative monitoring may help prevent complications such as vessel injury or embolic recurrence. Additionally, clinicians should be aware of the limitations of early DWI (Diffusion-weighted imaging) in detecting brainstem infarcts and of the need for clinical vigilance in the postoperative period.