Brainstem Infarction Due to a Basilar Arterial Web

HomeRadiologyVol. 309, No. 2 PreviousNext Reviews and CommentaryFree AccessImages in RadiologyBrainstem Infarction Due to a Basilar Arterial WebJun Li* , Lizhang Chen*Jun Li* , Lizhang Chen*Author AffiliationsFrom the Department of Neurology, Affiliated Hospital of Guizhou Medical University, No. 28 Guiyi St, Yunyan District, Guiyang, Guizhou 550031, China (J.L.); and Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (L.C.).Address correspondence to J.L. (email: [email protected]).Jun Li* Lizhang Chen*Published Online:Nov 14 2023https://doi.org/10.1148/radiol.231106MoreSectionsPDF ToolsAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In * J.L. and L.C. contributed equally to this work.A 34-year-old man with no significant past medical history presented with sudden-onset dizziness and slurred speech lasting 2 hours. National Institutes of Health Stroke Scale, or NIHSS, score was 6 (verbally arousable, correctly answered one question, partial hemianopia, ataxia, mild sensory loss, and moderate dysarthria). Basic laboratory tests, which included blood gas analysis, finger stick blood glucose, complete blood count, and electrolyte and coagulation tests, were conducted, and the results were all within normal range. An electrocardiogram was also normal. Unenhanced head CT did not reveal any hemorrhage. CT angiography showed severe stenosis of the distal basilar artery (Figure, B). The patient was treated with recombinant tissue plasminogen activator, and his National Institutes of Health Stroke Scale score improved to 2 (mild sensory loss and dysarthria). MRI showed an acute left paramedian pontine infarction (Figure, A). MRI and digital subtraction angiography demonstrated a thin, smooth, and membranous intraluminal filling defect in the distal basilar artery (Figure, C and D). The patient was diagnosed with brainstem infarction due to a basilar artery web and was treated with a daily dose of 100 mg of aspirin.Images in a 34-year-old man who presented with sudden-onset dizziness and slurred speech lasting 2 hours. (A) Axial diffusion-weighted MRI scan shows acute ischemic infarct in the left paramedian pons. (B) Sagittal CT angiogram of the head, (C) sagittal high-resolution black-blood MRI scan of the brain, and (D) selective angiogram of the vertebral artery from digital subtraction angiography in lateral projection show a membranous intraluminal filling defect (arrow), consistent with a distal basilar artery web.Download as PowerPointArtery webs, an intimal variant of fibromuscular dysplasia, are increasingly recognized in the cervical and cerebral arteries. Basilar artery web has been rarely reported but needs to be considered as a potential cause of ischemic posterior circulation stroke, especially in young patients (1,2).Disclosures of conflicts of interest: J.L. No relevant relationships. L.C. No relevant relationships.* J.L. and L.C. contributed equally to this work.References1. Esenwa C, Labovitz D, Caplan LR. “Basilar web” causing basilar branch infarction. J Stroke Cerebrovasc Dis 2019;28(11):104366. Crossref, Medline, Google Scholar2. Green DM, Caplan LR. Recurrent basilar branch infarcts due to a protruding basilar artery lesion. Cerebrovasc Dis 2000;10(6):489. Crossref, Medline, Google ScholarArticle HistoryReceived: Apr 29 2023Revision requested: June 2 2023Revision received: Aug 7 2023Accepted: Aug 17 2023Published online: Nov 14 2023 FiguresReferencesRelatedDetailsRecommended Articles Multimodality Imaging of Vertebrobasilar Dolichoectasia: Clinical Presentations and Imaging SpectrumRadioGraphics2016Volume: 36Issue: 4pp. 1129-1146Ischemic Infarction in Young Adults: A Review for RadiologistsRadioGraphics2019Volume: 39Issue: 6pp. 1629-1648Acute Symptomatic Basilar Artery Stenosis: MR Imaging Predictors of Early Neurologic Deterioration and Long-term OutcomesRadiology2016Volume: 280Issue: 1pp. 193-201Mechanical Thrombectomy in Subtypes of Basilar Artery Occlusion: Relationship to Recanalization Rate and Clinical OutcomeRadiology2019Volume: 291Issue: 3pp. 730-737Combined Use of X-ray Angiography and Intraprocedural MRI Enables Tissue-based Decision Making Regarding Revascularization during Acute Ischemic Stroke InterventionRadiology2021Volume: 299Issue: 1pp. 167-176See More RSNA Education Exhibits Posterior Circulation Stroke: How Much Do You Know About It?Digital Posters20223-dimensional High-Resolution Magnetic Resonance Vessel Wall Imaging For The Evaluation Of Rare Cerebrovascular PathologiesDigital Posters2021MRI Evaluation Of Thrombectomy Candidates In Acute Ischemic Stroke (AIS): Is It Time For A Change?Digital Posters2021 RSNA Case Collection Basilar Artery EntrapmentRSNA Case Collection2021Acute thrombosed basilar tip aneurysmRSNA Case Collection2021Carotid WebRSNA Case Collection2020 Vol. 309, No. 2 Metrics Altmetric Score PDF download