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{
    "pk": 48350,
    "title": "Report of Two Cases: Altered Mental Status and Anisocoria as Presenting Symptoms in Acute Basilar Artery Occlusion",
    "subtitle": null,
    "abstract": "<p><strong>Introduction</strong>: A posterior circulation stroke at the level of the basilar artery can cause ischemia to the brainstem, cerebellum, and occipital lobes.<br>Posterior circulation strokes are notoriously more difficult to clinically diagnose than anterior circulation strokes, with a variety of presenting symptoms including altered mental status, dizziness, vision changes, nausea, and vomiting. Anisocoria has been reported to occur in rare cases.</p>\n<p><strong>Case Report</strong>: We present two cases where patients had an acute episode of altered mental status with a key exam finding of anisocoria, or unequal pupil sizes. The combination of anisocoria<br>and acute mental status decline are classically associated with traumatic brain injury, increased intracranial pressure, or both. In each of the two cases presented, acute basilar artery occlusion was seen on computed tomography with angiography.</p>\n<p><strong>Conclusion</strong>: When presented with acute decline in mental status and anisocoria, early clinicalsuspicion of an acute basilar artery occlusion is crucial in diagnosing and managing these patients<br>with debilitating acute posterior stroke. Time-sensitive interventions such as thrombolytics and mechanical thrombectomy can be lifesaving.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "anisocoria"
        },
        {
            "word": "altered mental status"
        },
        {
            "word": "basilar artery occlusion"
        },
        {
            "word": "posterior stroke"
        }
    ],
    "section": "Case Series",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/5bp46915",
    "frozenauthors": [
        {
            "first_name": "Andrew",
            "middle_name": "",
            "last_name": "Ryu",
            "name_suffix": "",
            "institution": "South Shore University Hospital/Northwell Health, Department of Emergency Medicine, Bay Shore, New York",
            "department": ""
        },
        {
            "first_name": "Karizma",
            "middle_name": "",
            "last_name": "Chhabra",
            "name_suffix": "",
            "institution": "South Shore University Hospital/Northwell Health, Department of Emergency Medicine, Bay Shore, New York",
            "department": ""
        },
        {
            "first_name": "Thomas",
            "middle_name": "",
            "last_name": "George",
            "name_suffix": "",
            "institution": "South Shore University Hospital/Northwell Health, Department of Emergency Medicine, Bay Shore, New York",
            "department": ""
        },
        {
            "first_name": "Elizabeth",
            "middle_name": "",
            "last_name": "Kasparov",
            "name_suffix": "",
            "institution": "South Shore University Hospital/Northwell Health, Department of Emergency Medicine, Bay Shore, New York",
            "department": ""
        },
        {
            "first_name": "Mohamed",
            "middle_name": "",
            "last_name": "Wali",
            "name_suffix": "",
            "institution": "South Shore University Hospital/Northwell Health, Department of Emergency Medicine, Bay Shore, New York",
            "department": ""
        },
        {
            "first_name": "Christopher",
            "middle_name": "C.",
            "last_name": "Lee",
            "name_suffix": "",
            "institution": "South Shore University Hospital/Northwell Health, Department of Emergency Medicine, Bay Shore, New York",
            "department": ""
        }
    ],
    "date_submitted": "2025-05-28T20:15:02.348000Z",
    "date_accepted": "2025-07-25T13:21:03.227000Z",
    "date_published": "2025-09-24T03:20:00Z",
    "render_galley": null,
    "galleys": [
        {
            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/48350/galley/40132/download/"
        }
    ]
}