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Stroke from basilar artery occlusion is associated with a poor natural history with high rates of death and disability. Intravenous thrombolysis administered within 4.5 hours of last known well time improves the odds of a good neurological outcome after ischemic stroke, including in patients with basilar artery occlusion. Thrombectomy for basilar artery occlusion has had mixed outcomes. The WAKE-UP randomized clinical trial demonstrated that administration of intravenous thrombolysis can benefit select patients with wake-up strokes whose brain MRI shows restricted diffusion but no accompanying T2 FLAIR change. We report a case of a wake-up acute ischemic stroke presenting with acute vertigo followed by progressive brainstem dysfunction from a basilar artery occlusion. The patient was successfully treated with intravenous thrombolysis beyond 4.5 hours of last known well and symptom discovery time according to an MRI tissue-based approach resulting in partial recanalization of her basilar artery and recovery to near normal. This case suggests that hyperacute MRI can serve as a tissue clock to select patients with wake-up stroke for acute reperfusion therapy even if they do not meet standard trial inclusion criteria, including patients with basilar artery occlusion.

ObjectiveHypertensive urgency, defined as acutely elevated BP without target organ damage, is associated with an increased risk of adverse cardiovascular events and accounts for a substantial proportion of national emergency department (ED) visits. To advance research in this space, we sought to validate the newICD-10-CMdiagnostic code for hypertensive urgency within a single healthcare system.MethodsWe performed a retrospective chart-review study of ED encounters at Weill Cornell Medicine from 2016 – 2021. We randomly selected 25 encounters with theICD-10-CMcode I16.0 as the primary discharge diagnosis and 25 encounters with primaryICD-10-CMdischarge diagnosis codes for benign headache disorders. A single board-certified vascular neurologist reviewed all 50 encounters while blinded to the assignedICD-10-CMcodes to identify cases of hypertensive urgency. We calculated the sensitivity, specificity, and positive predictive values of theICD-10-CMcode I16.0 with 95% confidence intervals (CI).ResultsOut of 50 randomly selected ED encounters, 24 were adjudicated as hypertensive urgency. All encounters adjudicated as hypertensive urgency had been assigned theICD-10-CMdischarge diagnosis code of I16.0. All 25 of the encounters adjudicated as headache were assigned anICD-10-CMdischarge diagnosis code for a benign headache disorder. TheICD-10-CMcode for hypertensive urgency, I16.0, was thus found to have a sensitivity of 100% (95% CI: 86-100%), specificity of 96% (95% CI: 80-100%), and positive predictive value of 96% (95% CI: 78-99%).ConclusionWe found that the newICD-10-CMcode for hypertensive urgency, I16.0, can reliably identify patients with this condition.