Spontaneous Occlusion of a Large Fusiform Basilar Artery Dissecting Aneurysm in a Child Complicated with Brainstem Infarction: a case report

Basilar artery dissecting aneurysms, although very rare in children, may be associated with severe morbidity and mortality. The management of these vascular lesions depends on clinical presentation of patients. Large fusiform vertebro-basilar dissecting aneurysms are exceedingly rare and can exert mass effect on the brainstem and cerebellum. We herein report the neuroimaging findings, including MRI, MR angiography, diffusion-weighted imaging, and conventional angiography, in a four-year-old boy with a large fusiform basilar artery dissecting aneurysm complicated with brainstem infarction. The implications of neuroimaging findings on the decision to treat this patient are also discussed. Correspondence Author to: Alex Mun-Ching Wong Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan No. 5, Fu-Xing Street, Gui-Shan, Taoyuan 333, Taiwan J Radiol Sci 2013; 38: 31-34 Fusiform basilar artery dissecting aneurysm 32 J Radiol Sci March 2013 Vol.38 No.1 with reduced water diffusion demonstrated by diffusionweighted imaging. MRA showed complete occlusion of the distal basilar artery. These imaging findings were consistent with a basilar artery dissecting aneurysm complicated with acute brainstem infarction. Transfemoral angiography of the vertebro-basilar system confirmed complete occlusion of the basilar artery occlusion. Angiography of the bilateral internal carotid arteries showed patent bilateral posterior cerebral arteries (PCAs) but no opacification of the distal basilar artery or superior cerebellar arteries. Without evidence of opacification of the aneurysm, further intervention was not performed. He was conservatively treated with anti-coagulation, and transferred to rehabilitation. Muscle power of his right extremities gradually improved. Followup MRI ten months later showed shrinkage of the aneurysm (Fig. 2) and persistent occlusion of the distal basilar artery. The brainstem was less compressed. At clinical follow-up three years later, he had a nearly complete recovery with mild numbess of the right extremities.