Top of the basilar thrombosis

Case contributed by Dr Bruno Di Muzio

Presentation

Nystagmus and vertigo on waking. Significant deterioration whilst in hospital - with right hemiplegia, and inability to protect airway.

Patient Data

Age: 54-year-old
Gender: Male
CT

CT Brain

There is a hyperdensity in the tip of the basilar artery in keeping with thrombosis. 

CT

CTA COW

The hyperdensity at the tip of the basilar artery is confirmed as a filling defect on CTA images consistent with thrombosis. Vertebral arteries and P2 segments of the posterior cerebral arteries opacify normally. Although there are resolution limitations, the superior cerebellar arteries appear to be involved. 

DSA (angiography)

Angiography - Clot retrieval

 

Initial diagnostic angiography showed truncation of the left posterior inferior cerebellar artery and occlusion of the distal basilar artery.

The left superior cerebellar artery filled proximally. A 6-French Envoy straight guide catheter was exchanged into the left vertebral artery. A Rebar 18 microcatheter was then positioned in the right posterior cerebral artery over a Synchro standard microwire, and a 4 x 20 Solitaire stent deployed from the P1 segment into the basilar artery. A single pass resulted in TICI2b revascularisation, with no change to the truncated left superior cerebellar and posterior inferior cerebellar arteries.​

CT

CT Brain 24 h later

 

Hypoattenuation of the left cerebellar hemisphere is in keeping with established infarct with mild oedema. Mild mass effect with some distortion but no effacement of the fourth ventricle and no tonsillar or transtentorial herniation.

The basilar tip is less prominently hyperdense.​

Case Discussion

Acute basilar artery occlusion that, even with successful clot retrieval treatment, evolved with a large area of cerebellar infarct on the left. 

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Case information

rID: 43680
Case created: 21st Mar 2016
Last edited: 27th May 2017
Inclusion in quiz mode: Included

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