Presentation
Altered conscious state and 3rd nerve palsy.
Patient Data
Ventricular and sulcal atrophic changes are somewhat more than expected for
age. Mega cisterna magna noted.
No acute intracranial hemorrhage. Grey-white differentiation is preserved
with no convincing evidence of infarct.
The intracranial vasculture, including the basilar is slightly hyperdense.
There is moderate cavernous ICA calcific atheroma
Slight irregularity of the tip of the basilar artery is concerning for focal
dissection/ non-occlusive thrombus in this clinical setting.
Microcatheter was advanced into the right P1.
4 x 20mm Solitaire, one pass:
from right P1 into basilar trunk.
large amount of clot retrieved and sent for analyzes.
Good forward filling, TICI 3 achieved at 7:00am.
Axial DWI has been performed status post basilar tip clot retrieval,
confirming R >> L mesial midbrain, thalamic and to a lesser degree superior
left cerebellar diffusion restriction compatible with subacute infarction.
This corresponds reasonably well to subtle hypodensity documented in these
structures on yesterday's CT
Case Discussion
The fact that this is non-occlusive makes the diagnosis harder, but still essential.
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