Posterior circulation infarct

Case contributed by Dr Derek Smith

Presentation

Found unconscious at home. Well the night before. GCS 6 on arrival in emergency department.

Patient Data

Age: 55
Gender: Male
Modality: CT

Initally reported as normal examination.

On review of original non-contrast scan by neuro-radiologists hypodensities and loss of deep grey matter in thalamic areas noted.

Angiogram/venogram studies

Modality: CT

CTA/CTV performed with no evidence of AVM, dissection or occlusive pathology within limits of scan. Diffuse posterior circulation hypoperfusion when compared to ACA/MCA systems.

Modality: MRI

Restricted diffusion in posterior thalami, upper brainstem, right optic radiation (occipital lobe) and scattered infarct in left cerebellar hemisphere.

The patient remained obtunded and was managed in the intensive care unit under sedation and ventilation. He required feeding support as his swallow, conscious level and motor effort in general were impacted but slowly recovered.

There was a long rehabilitation period following this posterior circulation stroke. The patient remained broadly cognitively impaired with flucuant levels of alertness. He relied on assistance to mobilise with a frame and was left with severe visual impairment and limited downgaze.

Follow up study (eight months)

Modality: CT

Chronic infarcts in midbrain, bilateral medial thalami and right occiptal lobe.

No acute findings.

Case Discussion

This young patient suffered a debilitating posterior circulation stroke.  The long term effects of infarcting important structres in the brainstem and basal ganglia illustrates the importance of these structures and are important review areas in head imaging.

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Case Information

rID: 34367
Case created: 17th Feb 2015
Last edited: 4th Oct 2015
Inclusion in quiz mode: Included

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