Basilar thrombosis with haemorrhagic transformation

Case contributed by A.Prof Frank Gaillard

Presentation

Sudden onset loss of conciousness.

Patient Data

Age: 50 years
Gender: Male
CT

CT brain on admission

There is a hyperdense basilar tip. Subtle hypodensity is noted at the left anterior pons, which may be artefactual. Hypodensity at the left internal capsule posterior limb is consistent with prior lacunar nfarct. No intracranial haemorrhage or collections. No evidence of mass effect. Normal grey-white matter differentiation. Ventricles and sulci are age-appropriate. Hypoplastic frontal sinuses. Imaged calvarium and paranasal sinuses are otherwise clear.

CT

CTA at same time

There is poor opacification of the distal basilar artery/basilar tip likely reflecting CTA quality than a real finding. Both proximal P1 are poorly opacified by contrast, although distal P1 and the remainder of both PCA appear normal.

The patient immediately proceeded to a cerebral DSA and successful clot retrieval.

CT

CT brain next day

There are bilateral PCA territory haemorrhagic infarcts, with hyperdensity of the sulci consistent with laminar necrosis. Low density is also seen within the thalamus bilaterally, with haemorrhage seen within the left thalamus consistent with thalomo-perforator distribution infarcts (haemorrhagic on the left). There is an infarct also seen within the right cerebellum and middle cerebellar peduncle uncle. Likely further infarct seen within the left cerebellum. No obstruction/compression to the 4th ventricle. The high density within the basilar artery has resolved. When compared to the previous imaging there is diffuse cerebral oedema. No hydrocephalus identified.

MRI

MRI Brain Day 2

Very extensive infarction is demonstrated in the posterior circulation-bland infarcts with restricted diffusion shown in the posterior inferior cerebellar artery territory bilaterally, anterior inferior cerebellar artery territory, and the right superior cerebellar artery territory. Haemorrhagic change is demonstrated within the infarcts in both posterior cerebral artery territories within the occipital lobes, and in the left thalamus. Bland infarction shown on the right thalamus and bilateral midbrain. There are punctate areas of infarction seen in other vascular distributions, in particular to areas within the right middle cerebral artery, and peripherally in the left middle cerebral artery territory.

Case Discussion

The patient passed away a few days later.

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Case information

rID: 23569
Case created: 24th Jun 2013
Last edited: 20th Oct 2017
Inclusion in quiz mode: Included

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