Basilar and bilateral vertebral artery occlusion

Case contributed by Prof Peter Mitchell

Presentation

Hemiparesis - rapid progression to collapse, GCS 3 intubated and transferred.

Patient Data

Age: 70 years
Gender: Male

Hyperdense basilar artery extending into PCA.

Modality: DSA (angiography)

LVA origin occluded, guide passed, stent and aspiration catheter clot retrieval, angioplasty then stent to ostial disease, finally further thrombectomy and angioplasty of distal C1/2 segment. Good revascularisation and reperfusion.

Case Discussion

Diagnosis delayed as presented with unilateral weakness.  Progressed while in ED to collapse.  A stuttering onset is seen in between 1/3 and 2/3 of case of basilar occlusion.  The full hand of altered conscious state, bilateral weakness, and ophthalmaplegia and other brainstem signs do not have to be present to suspect this condition.

Hyperdense basilar artery can be the clue to the diagnosis if not suspected clinically and prompt further imaging.

The bilateral vertebral artery occlusions were not initially recognised as the patient was referred for intracranial clot retrieval - but early recognition allowed appropriate planning of the intervention.

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Case Information

rID: 45592
Case created: 31st May 2016
Last edited: 22nd Mar 2017
Inclusion in quiz mode: Included

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