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LETTER TO EDITOR
Year : 2021  |  Volume : 69  |  Issue : 5  |  Page : 1434-1435

Basilar Artery Aneurysm Presenting as a Stroke Mimic


Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Date of Submission19-Jul-2017
Date of Decision09-Aug-2017
Date of Acceptance11-Oct-2019
Date of Web Publication30-Oct-2021

Correspondence Address:
Gentle S Shrestha
Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Maharajgunj - 44600, Kathmandu
Nepal
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.329592

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How to cite this article:
Shrestha GS, Keyal N. Basilar Artery Aneurysm Presenting as a Stroke Mimic. Neurol India 2021;69:1434-5

How to cite this URL:
Shrestha GS, Keyal N. Basilar Artery Aneurysm Presenting as a Stroke Mimic. Neurol India [serial online] 2021 [cited 2021 Dec 2];69:1434-5. Available from: https://www.neurologyindia.com/text.asp?2021/69/5/1434/329592




Sir,

A 65-year-old male patient presented with the history of sudden onset weakness of left side of the body with decreased level of consciousness. He had the symptoms for three hours at the time of presentation. On examination, his Glasgow Coma Scale was 13 (E3, M6, V4) with motor power of 1/5 in left half of the body. His heart rate was 84 beats/minute, respiratory rate was 18/minute, blood pressure was130/80 mm Hg and was maintaining SPO2 of 95% at room air. His complete blood count, blood sugar, serum electrolytes, and coagulation profile was normal. With the provisional diagnosis of stroke, patient underwent CT scan of head, which revealed a homogenous opacity at the level of brainstem, with compression of right cerebral peduncle and hydrocephalus [Figure 1]. CT angiography revealed basilar artery aneurysm [Figure 2]. Coronal section showed fusiform dilatation of basilar artery with obstruction of third ventricle [Figure 3]. Patient underwent ventriculo-peritoneal shunt for hydrocephalus and conservative management for basilar aneurysm. There was progressive improvement in the level of consciousness and his motor power improved to 4/5 in left side.
Figure 1: Homogenous opacity at the level of brainstem with peripheral calcification, involving basilar artery (marked by vertical arrow), with compression of cerebral peduncle in right side and hydrocephalus (marked by horizontal arrow)

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Figure 2: CT angiography showing basilar artery aneurysm (marked by arrow)

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Figure 3: Coronal section showing fusiform dilatation of basilar artery with obstruction of third ventricle (marked by arrow)

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Stroke mimics are not uncommon in clinical practice. They are found in 13 to 19% of patients presenting with the clinical features of stroke.[1],[2] Identifying stroke mimics is increasingly important in the era of interventional stroke therapies with potential adverse effects.[3] In this patient, careful observation of non-contrast CT head revealed possible basilar artery aneurysm. Subsequent CT angiography confirmed the diagnosis, which showed fusiform dilatation of basilar artery. Left-sided hemiparesis is due to the compression of right cerebral peduncle by the aneurysm. Decreased level of consciousness is explained by hydrocephalus due to obstruction of third ventricle. Previous articles and findings, related to fusiform dilatation of basilar artery resulting in stroke-like presentation, is elaborated in [Table 1]. Initial plan for thrombolysis was differed and patient underwent placement of ventriculo-peritoneal shunt, with subsequent clinical improvement. The potential harm of thrombolytic therapy was avoided, respecting the principle of medical ethics—nonmaleficence.[4],[5],[6],[7],[8],[9]
Table 1: Articles and findings, related to fusiform dilatation of basilar artery resulting in stroke like presentation

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Norris JW, Hachinski VC. Misdiagnosis of stroke. Lancet 1982;1:328-31.  Back to cited text no. 1
    
2.
Libman RB, Wirkowski E, Alvir J, Rao TH. Conditions that mimic stroke in the emergency department. Implications for acute stroke trials. Arch Neurol 1995;52:1119-22.  Back to cited text no. 2
    
3.
Huff JS. Stroke mimics and chameleons. Emerg Med Clin North Am 2002;20:583-95.  Back to cited text no. 3
    
4.
Jauch EC, Saver JL, Adams HP Jr, Bruno A, Connors JJ, Demaerschalk BM, et al. Guidelines for the early management of patients with acute ischemic stroke: A guidelines for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.  Back to cited text no. 4
    
5.
Bledsoe TA, Levy MM. Basic ethical principles in critical care. In: Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink MP, editors. Textbook of Critical Care. 6th ed. United States of America: Saunders; 2011. p. 1573-5.  Back to cited text no. 5
    
6.
Yuan YJ, Xu K, Lyo Q, Yu JL. Research progress on vertebrobasilar dolichoectasia. Int J Med Sci 2014;11:1039-48.  Back to cited text no. 6
    
7.
Bazerra S, Casaroto E, Bueno Alves M, Ierardi Goulart L, Annes M, Sampaio Silva G. The challenge of managing fusiform basilar artery aneurysms: From acute ischemic stroke to a massive subarachnoid hemorrhage. Case Rep Neurol 2011;3:50-3.  Back to cited text no. 7
    
8.
Pearl MS, Tamargo R, Gailloud P. Middle cerebral artery branch occlusion mimicking a saccular aneurysm on 3D digital subtraction angiography. J Neurosurg 2008;109:1123-5.  Back to cited text no. 8
    
9.
Wijdicks EF. Giant fusiform aneurysm presenting as fatal basilar artery occlusion. Mayo Clin Proc 1997;72:437-9.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

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