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Washington University Experience | VASCULAR | Infarct - Hemorrhagic | 3A0 Case 3 History
Case 3 History ---- The patient was a 41 year old man without significant past medical history, who awakened on 05/19 with vertigo, decreased extraocular movements, and right sided weakness. On admission he had become hemiplegic (right greater than left) with cranial nerve deficits. A CT/CT angiogram on 5/19 showed thrombosis within the midportion of the basilar artery with some collateral flow to the bilateral superior cerebellar arteries from PICA/AICA collaterals, and developing infarction in the left cerebellar hemisphere. Mechanical thrombectomy of the basilar clot was performed using an aspiration system and a stent retrieval device. Final angiography showed restoration of flow across the basilar artery, but with some residual filling defect. Brain MRI on 5/20 showed multiple evolving infarcts involving the cerebellar hemispheres (left greater than right), the left cerebellar vermis, the pons, and the medial right occipital lobe. There was also interval enlargement of the lateral and third ventricles, likely caused by mass effect and compression of the cerebral aqueduct. He was intubated and transferred to the Neurological ICU. He did not have cough, corneal, or pupillary light reflexes. An apnea test was performed and he was declared brain dead on 5/20. ---- Autopsy showed the weight of the unfixed brain was 1650g. An acute bilateral hemorrhagic infarct involved the superior cerebellar artery territories, with secondary hemorrhage and residual basilar artery thrombus. There is no evidence of infection, vasculitis, significant atherosclerosis, or clearly embolic material. The primary etiology of the basilar artery thrombosis remained unclear.
