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Megadolicho basilar artery anomaly complicated by a thrombosed fusiform aneurysm and a left pontine stroke

Author: 
Rajaonarison Lala Andriamasinavalona, Ramarokoto Mijoro, Rasaholiarison Nomena Finiavana, Injakanasy Innocent, Dan-Chebut Octavia, Razafimahefa Julien and Tehindrazanarivelo Alain Djacoba
Subject Area: 
Health Sciences
Abstract: 

We report a case of a 40-year-old man who had been seen for a sudden onset of a vertical binocular diplopia in the left lateral gaze. The patient had high blood pressure, was an active smoker and overweight. His clinical examination showed a complete paralysis of the left VI cranial nerve. Brain MRI in vascular sequence with injection showed a left pontine hypersignal in diffusion (left pontine stroke). Also the presence of mega-dolicho basilar artery associated with a fusiform aneurysm, with parietal thrombus measuring 20 mm in axial section with circulating lumen of 8 mm and a significant mass effect on the left protuberance, without any signs of rupture or bleeding. A surgical therapeutic abstention was decided, the patient was treated by antihypertensive and antiplatelet drugs. Brain MRI with angio-MRI sequence is important for the diagnosis and the search for mega-dolicho basilar artery complications (ischemia, hemorrhage and compression). Complex aneurysms of the basilar artery represent a therapeutic challenge, both neurosurgical and endovascular.

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