Basilar artery stroke

Case contributed by Yaïr Glick
Diagnosis certain

Presentation

Loss of consciousness.

Patient Data

Age: 70 years
Gender: Female
ct

Hypodense area in left side of pons, in keeping with acute pontine infarct.
Hyperdense basilar artery.
Bifrontal subcortical leukoaraiosis.

The CT angiogram confirms a thrombus in the basilar artery.
The thin right vertebral artery is invisible distal to the origin of the right PICA.
The intracranial portion of the left vertebral artery (V4) is hypodense in comparison to other arteries.

Case Discussion

Passed out while doing the dishes. Evacuated by ambulance. On arrival to the ER, her eyes were open and she reacted to pain and to her name being called; flaccid tone, pupils equal but constricted. A CT scan was done and reported immediately. Once a thrombus was identified in the basilar artery, she was intubated under propofol and rocuronium bromide and started on tPA treatment, which was maintained along with propofol, until she underwent successful thrombectomy.

Post-procedure CT (not available): a new small parasagittal right occipital infarct appeared and the left pontine infarct now crossed the midline, most probably due to cytotoxic edema.

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