Presentation
Acute altered level consciousness, quadriplegia, and pinpoint pupils. Background of diabetes and hypertension. Normal CT brain.
Patient Data
There are abnormal signal intensities that are T1 hypointense, T2 hyperintense, and FLAIR hyperintense, with evidence of diffusion restriction primarily to the right cerebellar hemisphere, with small affected areas seen in the left cerebellar hemisphere, brain stem, and pons. There is lesser extension down to the medulla oblongata and up to midbrain. In addition, there are small regions of the hypointense signal in the SWI sequence.
There are small scattered subcortical areas in both cerebral hemispheres suggestive of lacunar infarctions or small vessel ischemic changes.
MRA sequences demonstrate total absence of flow signal intensity in the right vertebral artery and basilar artery, in keeping with total thrombosis.
MRV sequences show normally visualized and developed major dural venous sinuses with no abnormal flow signal intensity within.
Conclusion:
Findings are consistent with acute infarction in the vertebrobasilar artery territory with minor petechial hemorrhagic change.
Case Discussion
This is a case of vertebrobasilar territory acute infarctions in a middle-aged patient with a background of diabetes and hypertension. Due to strong clinical suspicion of a posterior circulation stroke, an MRI Brain was requested urgently.
The patient was admitted to the ICU.
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