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Images in Neurology
October 2006

Bilateral Pontine Infarction Secondary to Basilar Trunk Saccular Aneurysm

Arch Neurol. 2006;63(10):1498-1499. doi:10.1001/archneur.63.10.1498

Basilar trunk aneurysms are rare,1 fusiform in shape,2 and mainly present by compression or atherothrombosis of the brainstem.3 We report the case of an obese 50-year-old man, known to be hypertensive, who presented with a sudden onset of severe occipital headache, difficulty communicating, dizziness, and inability to move. Neurological examination showed the patient to be dysarthric, dysphagic, and quadriplegic. Several hours later, he developed respiratory failure and required a tracheotomy and ventilation. Brain computed tomography (CT) and magnetic resonance imaging scans showed a large aneurysm arising from the basilar artery trunk, with minimal caudal pontine compression but bilateral pontine infarction (Figure 1). Four-vessel angiogram was undertaken, and a right vertebral angiogram showed a 14-mm saccular aneurysm, projecting to the right, with a wide neck, arising from the midbasilar trunk located between the anterior inferior cerebellar artery and superior cerebellar artery branches (Figure 2). Endovascular treatment by stent-supported coil embolization of the aneurysm was undertaken via the right vertebral artery. Dysphagia necessitated placement of a percutaneous endoscopic gastrostomy.

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