Basilar artery infarct with hyperdense basilar artery sign

Case contributed by Kamil Bekalarek


Sudden neurological deterioration.

Patient Data

Age: 75 years
Gender: Female

Hyperdense tip of the basilar artery in keeping with clot within the artery lumen.

Hypodense areas indicative of acute ischemic damage in upper portions of the cerebellar hemispheres, midbrain and thalami on both sides.


CT head two days later

There has been interval increase in the extent of edema in the infarcted areas in upper portions of cerebellar hemispheres, midbrain and both thalami (more prominent on the left side). This is associated with increased obliteration of the infratentorial surface markings and mild inferior displacement of the cerebellar tonsils.

The fourth ventricle is significantly compressed and the third ventricle is moderately compressed from the left side. Both lateral ventricles are mildly dilated comparing to the previous examination without signs of transependymal edema.

Case Discussion

This case nicely demonstrates the hyperdense basilar artery sign and ischemic stroke within the basilar artery territory. 

Rapidly increasing infratentorial edema, as seen in the follow-up exam in this case, can lead to neurosurgical emergencies such as hydrocephalus or tonsillar herniation, thus detection of early signs of these complications is important.

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Case information

rID: 78274
Published: 1st Jun 2020
Last edited: 8th Mar 2021
Inclusion in quiz mode: Included

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