Basilar and posterior cerebral artery hyperdense clots


Three key messages:

  • It is not uncommon to miss a basilar artery hyperdense clot, especially in the presence of extensive metallic artifacts as shown above. It is crucial to have a high index of suspicion for top of the basilar syndrome when a there is a typical history of visual disturbance, fixed pupils, reduced GCS and agitation.
  • One should be mindful of the common ''satisfaction of search'' trap. It's infrequent to have two hyperdense clots on one scan.
  • Lastly, if in doubt, performing intracranial angiogram would either confirm or refute suspicion.

This lady - unfortunately- passed away as was not deemed suitable for thrombectomy.