Vertebrobasilar Artery Dissection

摘要

Object: Isolated basilar artery dissection, is an uncommon clinical event that may present as stroke. It has rarely been reported as gross and microscopic autopsy findings. Methods: We describe a 46-year old man found unconscious and in the hospital a computerized tomography scan of the head showed cerebellar and brainstem infarct. He became comatose and died after a brief hospitalization without intervention. The basilar artery showed an acute tear of the intima and media with associated acute thrombosis. Basilar artery dissection alone presents clinically as stroke due to either thrombosis or subarachnoid hemorrhage (SAH). The presence of thrombosis or SAH depends on the plane of dissection. Classically, angiographic studies are used to confirm the diagnosis. The mortality rate for this disorder is expectantly high. Treatment is typically supportive.Conclusion: We report the clinical, gross, and microscopic findings of basilar artery dissection infarction of the cerebellum and brainstem. Case Report A 46-year-old white man was found unconscious in the field, was resuscitated and intubated on site. On admission to the hospital, the patient was found to be hypotensive (52/31 mmHg), with a pulse of 92 beats per minute, oxygen saturation of 100 % and Glasgow Coma Scale of 3. Past history includes diabetes, hypercholesterolemia and smoking. The patient was given intravenous fluid and dopamine. Physical examination revealed loss of corneal and oculovestibular reflexes. CT scan of the head showed evolving subtotal cerebellar infarct and associated brain stem and midbrain infarct with edema (Figure 1).