| Summary: | To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Download Hér er lýst sjúkratilfelli 22 ára gamallrar hraustrar konu sem komið var með meðvitundarlausa á bráðamóttöku Landspítala sumarið 2018. Tölvusneiðmynd af heila við komu sýndi stórt drep í litla heila hægra megin og mikinn bjúg sem þrengdi að fjórða heilahólfi. Æðamynd við komu vakti grun um flysjun í vinstri hryggslagæð og lokun botnslagæðar sem var staðfest síðar við innæðameðferð. Hafin var segaleysandi meðferð en síðan farið í segabrottnám og fékkst góð enduropnun æðar. Daginn eftir fór hún í skurðaðgerð vegna illvígs dreps í litla heila. Henni farnaðist vel og skoraði 1 stig á endurbættum Rankin-kvarða 90 dögum eftir úrskrift af sjúkrahúsi. This paper is a case report of a 22 year old, previously healthy woman that presented comatose to the Emergency Room at Landspitali University Hospital Iceland. A CT image of the head on admission revealed a large right cerebellar infarct with oedema compressing the fourth ventricle. A CT angiogram on admission was suspicious for a dissection of the left vertebral artery (confirmed during endovascular treatment) and a total occlusion of the distal third of the basilar artery. Thrombolytic therapy with t-PA was initiated followed by thrombectomy with good recanalization. The following day the patient underwent suboccipital craniotomy for malignant cerebellar infarction. She made a good clinical recovery to a modified Ranking scale of 1 at 90 days after discharge from the hospital. Following the case is a literature review on the clinical aspects of occlusion of the vertebrobasilar system, use and utility of imaging and treatment with (anticoagulation, IV and IA thrombolysis) modalities that have been tried. Finally, the evidence regarding thrombectomy and the role of craniotomy for malignant stroke are reviewed.
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