Presentation
Nystagmus and vertigo on waking. Significant deterioration whilst in hospital - with right hemiplegia, and inability to protect airway.
Patient Data
There is a hyperdensity in the tip of the basilar artery in keeping with thrombosis.
The hyperdensity at the tip of the basilar artery is confirmed as a filling defect on CTA images consistent with thrombosis. Vertebral arteries and P2 segments of the posterior cerebral arteries opacify normally. Although there are resolution limitations, the superior cerebellar arteries appear to be involved.
Initial diagnostic angiography showed truncation of the left posterior inferior cerebellar artery and occlusion of the distal basilar artery.
The left superior cerebellar artery filled proximally. A 6-French Envoy straight guide catheter was exchanged into the left vertebral artery. A Rebar 18 microcatheter was then positioned in the right posterior cerebral artery over a Synchro standard microwire, and a 4 x 20 Solitaire stent deployed from the P1 segment into the basilar artery. A single pass resulted in TICI2b revascularization, with no change to the truncated left superior cerebellar and posterior inferior cerebellar arteries.
Hypoattenuation of the left cerebellar hemisphere is in keeping with established infarct with mild edema. Mild mass effect with some distortion but no effacement of the fourth ventricle and no tonsillar or transtentorial herniation.
The basilar tip is less prominently hyperdense.
Case Discussion
Acute basilar artery occlusion that, even with successful clot retrieval treatment, evolved with a large area of cerebellar infarct on the left.
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