Presentation
The patient is asymptomatic. MRI follow-up. The history is withheld.
Patient Data
Dolichoectasia of basilar artery with giant fusiform aneurysm of the middle part (20 x 21 x 31 mm, AP x LL x CC) which is mostly thrombosed and compressing pons. The proximal part of the basilar artery is compressing the anterior medulla oblongata. Junctional dilatation of the basilar tip up to 6.5 mm, indenting the third ventricle floor, no CSF flow obstruction.
The A1 segment of the right anterior cerebral artery is not visualized on MR angiography, on the T1 postcontrast MPRAGE sequence is hypoplastic.
Left vertebral artery dominant, with enlarged V4 segment (predominantly before forming basilar artery). The right vertebral artery crosses the midsagittal line, touching the right anterior surface of the spinal cord.
Other findings include small pontine ischemic sequelae, supratentorial cerebral small vessel disease, and AICA loop type I/II in the right cerebellopontine angle.
Case Discussion
MRI and MRA follow-up of known giant basilar artery aneurysm that is mostly thrombosed. The patient had an appointment with an interventional neuroradiologist who is, at this point, not considering endovascular therapy due to the high risk of complications, higher than the natural course of the disease.
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