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We studied seven patients with brainstem infarction and large fusiform vertebrobasilar(VB)aneurysms to clarify the clinical,radiologic,and pathologic features.All presented with pontine infarcts;one also had a cerebellar infarct.VB TIAs preceded brainstem infarction in four patients. Angiography and CT documented VB fusiform aneurysmal dilatation.Four had intraluminal thrombi and one had severe basilar artery stenosis.Two distinct clinical pictures emerged:unilateral pontine infarcts with favorable outcome,presumably related to obstruction of a pontine penetrating artery at its origin from the posterior wall of the aneurysmal basilar artery,and major fatal bilateral pontine infarcts from basilar artery occlusion.Two patients came to autopsy.One had thrombus in the dilated basilar artery and a posterior cerebral artery branch embolus with hemorrhagic occipital infarction;the other had basilar artery thrombus with aneurysmal rupture and subarachnoid hemorrhage.Fusiform VB aneurysms caused brainstem stroke by intraluminal thrombus,local embolism, atherostenosis and obstruction of paramedian penetrating arteries. Subarachnoid hemorrhage is an uncommon complication. |
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aneurysm
aneurysm,fusiform
aneurysm,intracranial
aneurysm,vertebral basilar system
angiography,cerebral
angiography,posterior fossa
basilar artery occlusion
brainstem,infarction of
CAT scan
CAT scan,abnormal
cerebrovascular accident
neuropathology
occipital lobe,infarction
pons,infarction of
prognosis
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