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Posterior circulation infarct due to basilar artery thrombosis

Case contributed by Townsville radiology training
Diagnosis certain

Presentation

Found unconscious with fixed, dilated right pupil following alcohol and mixed drug use.

Patient Data

Age: 40 years
Gender: Male

Marked hypodensity of the midbrain and pons and large hypodense regions in the cerebellar hemispheres, more extensive on the right. Effacement of the prepontine cistern and cerebellar sulci due to vasogenic edema. Hyperdense segment in the basilar artery.

Acute infarction involving the posterior circulation including the brainstem (midbrain and pons) as seen on CT with interval increase in the degree of obstructive hydrocephalus and development of small intraventricular bleed as well as mild tonsillar herniation.

Complete occlusion of the basilar artery just distal to its formation with occlusion of the P1 segments of bilateral posterior cerebral arteries.

Brain Viability Study

Nuclear medicine

No uptake of isotope.

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