Basilar tip thrombosis
Hemiparesis and acute deterioration in conscious state.
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Hyperdense distal basilar artery and angiography confirmed a filling defect at the basilar tip. Successful recanalisation was achieved with intra-arterial thrombolysis.
Basilar artery thrombosis is a true neurointerventional emergency. It is most commonly due to an embolus but may also result from insitu thrombus on an atherosclerotic plaque or dissection. If not treated early, infarction of the brainstem results in rapid deterioration in conscious state and death.
The earliest sign on CT is a hyperdense basilar artery, which may be difficult to detect if the vessels are calcified, followed by signs of posterior circulation infarction in the brainstem, thalami and cerebellum. Treatment usually involves catheter-directed intra-arterial thrombolysis and intravenous heparin, which carries a risk of haemorrhage of up to 15%. Mechanical embolectomy with a clot retrieval device has been used in selected cases.
Credit: Dr Donna D'Souza.