Posterior circulation infarct: basilar artery occlusion
Nausea, vomiting and motor deficit on the left. Evolving rapidly to a severe decrease in the consciousness level requiring intensive care.
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MRI images demonstrating an extensive area of hyper T2/FLAIR signal abnormalities involving both the anterosuperior aspects of both cerebellar hemispheres, cerebellar vermis, pons, midbrain, both cerebral peduncles and the inferior thalami. It demonstrates high signal on DWI that correlates with diffusion restriction on the ADC map.
The brain has diffuse volume depletion in keeping with the patient's age group, with no lobar predominance. Multiple enlarged perivascular spaces are noted in the basal ganglia bilaterally. Old lacunar infarcts on the left. Moderate chronic small vessel ischaemic changes within the supratentorial white matter.
This case illustrates a subacute infarct involving the posterior circulation: vascular territories of the branches of the basilar artery, superior cerebellar arteries and posterior cerebral arteries bilaterally. A case like this one carries a terrible prognosis with a rapid deterioration in the level of consciousness and ultimately death. Unfortunately, the patient was not able to be treated with endovascular clot retrieval.