Acute basilar artery occlusion

Case contributed by Koen van Nieuwenhuizen
Diagnosis almost certain

Presentation

Patient presents with decreased consciousness (E1M2V1), fever (40.4C) and anisocoria with left pupil non-reactive to light, no corneal reflex on the left side. No nuchal rigidity. Last seen well c. 12 hours before presentation.

Patient Data

Age: 55 years
Gender: Male

On the axial non-contrast, there are extensive hypodensities in the thalamus, cerebellum, brain stem, mesencephalon, pons and mesiotemporal regions consistent with ischemia. Dense vessel sign of the basilar artery. Ventricles are symmetrical and non-dilated. Normal gyration. No indication of hemorrhage.

The contrast study demonstrated a total occlusion of the basilar artery at the vertebrobasilar junction. Only partial filling of the right posterior cerebral artery, P1 and P2.

The perfusion maps show perfusion defects on all 4 perfusion maps (only MTT shown) of the thalamus, cerebellum, brain stem, mesencephalon and pons.

Conclusion: Extensive ischemia of the posterior circulation due to an occlusion of the basilar artery.

Case Discussion

Extensive ischemia of the posterior circulation due to an occlusion of the basilar artery. Patient died after extubation.

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