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Images in Neurology |

Thrombosis in a Giant Basilar Trunk Fusiform Aneurysm

Yuji Kato, MD, PhD; Hidetaka Takeda, MD, PhD; Tomohisa Dembo, MD, PhD; Ichiro Deguchi, MD; Takuya Fukuoka, MD; Norio Tanahashi, MD, PhD
Arch Neurol. 2011;68(7):944-945. doi:10.1001/archneurol.2011.134.
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Basilar trunk aneurysm (also called dolichoectasia) is a relatively rare pathologic condition, and little is known about its natural history and optimal management.1 We describe a 66-year-old woman who had been receiving antihypertensive treatment and who presented with sudden left facial palsy. Her neurological symptoms deteriorated rapidly in the ambulance on the way to the hospital. Upon admission, she was unconscious and had left facial palsy and severe right arm and leg paresis. Cranial computed tomography revealed a giant fusiform aneurysm of the basilar artery with a thrombus in the lumen (Figure, A). Brain magnetic resonance imaging (MRI) revealed slightly restricted diffusion in the left pons with deformation caused by an aneurysm (Figure, B). Magnetic resonance angiography showed indistinct flow of the basilar artery, probably due to turbulence and slow flow (Figure, C). We applied basiparallel anatomic scanning (BPAS)–MRI2 to evaluate the surface of the vertebrobasilar artery. The technique required 2-cm-thick, heavily T2-weighted coronal imaging parallel to the clivus, with grayscale reversal during postprocessing. The BPAS-MRI confirmed a giant fusiform aneurysm of the basilar artery (Figure, D). The patient was treated with intravenous sodium ozagrel (a thromboxane A2 synthase inhibitor) and glycerol solution under strict blood pressure control. However, she remained comatose and required endotracheal intubation to maintain breathing. She died of respiratory arrest on the day after admission.

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Figure. Radiological images. A, Brain computed tomography shows a thrombus in a giant aneurysm of the basilar artery as a high-intensity lesion (arrows). B, Brain magnetic resonance imaging (MRI) shows slightly restricted diffusion in the left pons (arrows) with deformation caused by the aneurysm. C, A magnetic resonance angiogram shows indistinct flow in the basilar artery. D, Fusiform dilation of the basilar artery shows a mural thrombus (arrows) that was detected by basiparallel anatomic scanning–MRI (repetition time, 10 000 milliseconds; echo time, 548 milliseconds).




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