• Chan-Hyuk Lee, Seung-Ho Jeon, Sang Yeon Kim, Byoung-Soo Shin, and Hyun Goo Kang.
• Department of Neurology and Research, Institute of Clinical Medicine of Jeonbuk National University.
• Medicine (Baltimore). 2020 Sep 25; 99 (39): e22451.

RationaleShivering is an important physiological response of the body that causes muscle tremors to maintain temperature homeostasis. Traumatic brain injuries that affect the hypothalamus cause hypothermia, and physical removal of suprasellar tumors causes thermoregulation imbalance. However, no study has reported shivering due to ischemic stroke.Patient ConcernsA 58-year-old male patient was admitted to our emergency department to evaluate severe stenosis of the basilar artery. While waiting for further examination, he exhibited coarse shivering and severe dysarthria.DiagnosisBrain computed tomography angiography revealed occlusion of the entire basilar artery, and cerebral hypoperfusion was diagnosed in that area.InterventionsTransfemoral cerebral angiography (TFCA) was immediately performed, followed by thrombectomy of the basilar artery.OutcomesNeurological deficits, including shivering, were rapidly reversed. The same symptom reoccurred 5 hours later, and TFCA was performed for thrombectomy and stenting, and neurological symptoms immediately reversed. The patient's neurological symptoms did not worsen during hospitalization.LessonsPatients with acute basilar artery occlusion need prompt management because they have a higher mortality rate than those with other intracranial artery occlusions. When a patient exhibits neurological deficits accompanied by abrupt shivering for no specific reason, basilar artery occlusion must be considered.

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