Case Of the Week (COW) 20 Jan 2013
Answer:
Acute Basilar artery thrombosis with Bilateral Cerebellar Infarcts and Hydrocephalus.
Findings:
Low Attenuation areas noted in both cerebellar hemispheres with areas of hemorrhage . Ventricles are dilated. The basilar artery is hyperdense and relatively enlarged . Corresponding MRI images reveal restricted Diffusion with Gradient Blooming in above areas and Brainstem MR Angiogram images show no flow in Basilar artery.
Discussion:
Basilar artery Occlusion may present initially with non-specific prodromal symptoms like vertigo or headaches .These are followed by the hallmarks of BAO, including decreased consciousness, quadriparesis, pupillary and oculomotor abnormalities, dysarthria, and dysphagia. Early recognition is important since intravenous thrombolysis or endovascular treatment can be undertaken. The topographic distribution of infarcts in Basilar artery Occlusion is more common in pons, cerebellum and mesencephalon than medulla, thalami and occipital lobes. Basilar pons, cerebral crus and cerebellum hemisphere were more susceptible than pontine tegmentum, vermis, midbrain tegmentum and tectum. The branches with smaller lumen of basilar artery, which are easily affected could explain this phenomenon .
Ref: Acute basilar artery occlusion: topographic study of infarcts Neurol Res. 2008 May;30(4):341-3
Answer:
Acute Basilar artery thrombosis with Bilateral Cerebellar Infarcts and Hydrocephalus.
Findings:
Low Attenuation areas noted in both cerebellar hemispheres with areas of hemorrhage . Ventricles are dilated. The basilar artery is hyperdense and relatively enlarged . Corresponding MRI images reveal restricted Diffusion with Gradient Blooming in above areas and Brainstem MR Angiogram images show no flow in Basilar artery.
Discussion:
Basilar artery Occlusion may present initially with non-specific prodromal symptoms like vertigo or headaches .These are followed by the hallmarks of BAO, including decreased consciousness, quadriparesis, pupillary and oculomotor abnormalities, dysarthria, and dysphagia. Early recognition is important since intravenous thrombolysis or endovascular treatment can be undertaken. The topographic distribution of infarcts in Basilar artery Occlusion is more common in pons, cerebellum and mesencephalon than medulla, thalami and occipital lobes. Basilar pons, cerebral crus and cerebellum hemisphere were more susceptible than pontine tegmentum, vermis, midbrain tegmentum and tectum. The branches with smaller lumen of basilar artery, which are easily affected could explain this phenomenon .
Ref: Acute basilar artery occlusion: topographic study of infarcts Neurol Res. 2008 May;30(4):341-3