Top of basilar syndrome

Case contributed by A.Prof Frank Gaillard

Presentation

Altered conscious state and 3rd nerve palsy.

Patient Data

Age: 55 years
Gender: Male
CT

Ventricular and sulcal atrophic changes are somewhat more than expected for
age. Mega cisterna magna noted.
No acute intracranial haemorrhage. Grey-white differentiation is preserved
with no convincing evidence of infarct.
The intracranial vasculture, including the basilar is slightly hyperdense.
There is moderate cavernous ICA calcific atheroma

CT

Slight irregularity of the tip of the basilar artery is concerning for focal
dissection/ non-occlusive thrombus in this clinical setting.

DSA (angiography)

Microcatheter was advanced into the right P1.

4 x 20mm Solitaire, one pass:

from right P1 into basilar trunk.

large amount of clot retrieved and sent for analyses.
Good forward filling, TICI 3 achieved at 7:00am.

MRI

Axial DWI has been performed status post basilar tip clot retrieval,
confirming R >> L mesial midbrain, thalamic and to a lesser degree superior
left cerebellar diffusion restriction compatible with subacute infarction.
This corresponds reasonably well to subtle hypodensity documented in these
structures on yesterday's CT

Case Discussion

The fact that this is non-occlusive makes the diagnosis harder, but still essential. 

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Case information

rID: 23311
Case created: 4th Jun 2013
Last edited: 1st Nov 2015
Inclusion in quiz mode: Included

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