Presentation
Patient woke with vertigo and subsequently (over next hour) developed cranial nerve symptoms (ocular palsies) and decreased level of consciousness.
Patient Data
The top of the basilar artery is hyperdense.
CTA performed 20 minutes later confirms a filling defect involving the basilar tip and left P1 and SCA origin. The distal PCA fills via the PCOM.
Despite IV tissue plasminogen activator (tPA), a left superior cerebellar infarct is now visible.
Follow up CT confirms the evolution of a left-sided superior cerebellar artery infarct with substantial positive mass effect and developing hydrocephalus.