167: When a Stroke Doesn't Look Like a Stroke: Recognizing Basilar Artery Occlusions

How do you recognize a stroke when the usual symptoms are present? No facial droop. No slurred speech. No one-sided weakness.

In this episode, you'll hear the case of a post-op patient with normal vital signs but complaints of double vision. What follows is one of the most devastating types of ischemic stroke: a basilar artery occlusion.

Sarah walks through each decision that led to the patient's full recovery, from the bedside nurse's decision to activate the rapid response team, the the RRT nurse calling a stroke alert, to thrombectomy when thrombolytics weren’t an option. She also breaks down when common symptoms like dizziness should raise concern for basilar artery occlusion, why strokes like this one are so easy to miss with your typical FAST exam alone, and how a tour of the brain helps you predict neurological deficits.

Topics discussed in this episode:

• Why the nurse called rapid response for a post-op patient
• Anterior vs. posterior circulation
• Classic vs. atypical presentations of basilar artery occlusion
• Why FAST alone can miss posterior circulation strokes
• Locked-in syndrome and assessing consciousness
• Stroke localization: a tour of the brain
• IV thrombolytics: alteplase, tenecteplase, and bleeding risk
• When to use mechanical thrombectomy
• CT perfusion: core infarct vs. ischemic penumbra
• 5 important takeaways for your next neuro emergency

The American Heart Association/American Stroke Association's 2026 Guideline for the Early Management of Patients With Acute Ischemic Stroke:

https://www.ahajournals.org/doi/10.1161/STR.0000000000000513

Mentioned in this episode:

AND If you are planning to sit for your CCRN and would like to take the Critical Care Academy CCRN prep course you can visit https://www.ccrnacademy.com and use coupon code RAPID10 to get 10% off the cost of the course!

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