Thrombolytic therapy was carried out on four patients with brain stem stroke due to thromboembolism of the vertebrobasilar system. Diagnosis was confirmed by angiography. Clinical and instrumental findings indicated a very poor prognosis. Two of these patients were treated with urokinase and the other two with streptokinase for periods ranging from 16 to 44 hours. The interval between onset of symptoms and start of therapy was less than 10 hours for three of these patients. All made a gradual and almost complete recovery after only a few hours of treatment, and only one presented minimal residual neurological disability. The conditionof the fourth patient, who started therapy four days after the first episode, remained unchanged until he died 16 hours later.
Our observations suggest that thrombolytic therapy may be useful in treat ing recent acute life-threatening brain stem stroke.
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