AI Summary & Key Takeaways
AI InsightThis basilar artery stenosis in our patient was interesting not only for its rarity in neurological practice, but also for its aspect to be the first successful basilar artery stent placement case in our department.
📌 3 Key Takeaways
Abstract
Acute basilar artery occlusion having high mortality and morbidity risk may result in impairment of consciousness, bilateral pyramidal, sensorial and cerebellar signs, cranial nerve palsies or disturbances of conjugate eye movements due to emboli to both posterior cerebral and cerebellar arteries. A 72-year-old woman acutely developed dystonia of the right and tremor of the left hand improving in several hours which were followed by vomiting and an impairment of consciousness. The patient was somnolent for 2 days without any focal neurological signs. When she became alert we observed impaired cognitive performance, thalamic aphasia, cerebellar dysarthria, cerebellar signs and retraction of the left levator palbebra (Collier's sign), We also noted occasional attacks of the third cranial nerve paresis. Her cranial MRI showed bilateral cerebellar and thalamic infarcts prominent on the left side. Cerebral angiography revealed 90 % stenosis in basilar artery and 50 % in subclavian artery. On the 17th day of the illness, a stent was applied to the basilar artery. For this procedure, a guide catheter was placed in the right vertebral artery under general anesthesia and stenosis was passed by the use of a combination of a microcatheter and microguide wire Following this, a 2x20 mm-sized coronary balloon was used for the predilatation of the stenosis. Since the remaining stenosis was greater than 70 %, a 3.5x8 mm sized AVE stent was placed. During her radiological follow-up, no residual stenosis was detected. Low molecular weight heparin was given for 48 hours and she was started on ticlopidine. No major complications were observed except for Collier's sign becoming slightly prominent which regressed in a week. Her clinical status improved in several days. This basilar artery stenosis in our patient was interesting not only for its rarity in neurological practice, but also for its aspect to be the first successful basilar artery stent placement case in our department.
Özet
Baziler arter oklüzyonu, iki yanlı posterior serebral arter ve serebelluma giden arterlere emboli atarak bilinç bozukluğu ve bilateral piramidal, duysal, serebellar bulgular, kranyal nöropatiler veya konjuge bakış bozuklukları gibi zengin nörolojik bulgulara yol açabilir. Yetmiş iki yaşındaki hastada akut başlayıp saatler içinde düzelen sağ elde distoni, sol elde tremor geliştiği ve izleyen saatlerde bilincinin kapandığı öğrenildi. Somnolans halinin sürdüğü iki gün boyunca fokal nörolojik bulgu saptanmayan hastanın bilinci açıldıktan sonra apati, kognitif performansta düşüklük, talamik afazi, serebellar dizartri ve solda serebellar bulgular ve solda Collier belirtisi saptandı. Ayrıca birkaç kez sağda III. sinire ait geçici iskemik ataklar gözlendi. Kranyal MR'de solda daha geniş olmak üzere iki yanlı serebellar hemisfer ve talamuslarda infarkt ile uyumlu lezyonlar, serebral anjiyografide baziler arterde % 90, sol subklavian arterde % 50 düzeyinde stenoz saptandı. Hastalığının 17.gününde baziler artere anjiyoplastiyle stent uygulandı. Bunun için genel anestezi altında sağ vertebral artere kılavuz kateter yerleştirildi ve darlık mikrokateter mikro guidewire kombinasyonu kullanılarak geçildi. Daha sonra 2x20 mm'lik koroner balon kullanılarak darlığa predilatasyon uygulandı. Reziduel darlığın %70'den büyük olması nedeniyle 3.5x8 mm'lik AVE stent yerleştirildi. Yapılan kontrollerde reziduel darlık saptanmadı. Önemli bir komplikasyon görülmeyen hastada günler içinde belirgin klinik düzelme gözlendi. Nörolojide seyrek rastlanan baziler arter stenozu olgumuzu, kurumumuzda ilk kez stent uygulanarak başarılı sonuç elde edilmesi nedeniyle sunmayı uygun bulduk