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Department of Neurology, New England Medical Center and Tufts University School of Medicine, Boston, MA(Drs. Pessin, Chimowitz, Adelman, and Caplan)
Department of Radiology, New England Medical Center and Tufts University School of Medicine, Boston, MA (Dr. Kwan)
Department of Pathology, New England Medical Center and Tufts University School of Medicine, Boston, MA (Dr. Adelman)
Department of Neurology, Henry Ford Hospital, Detroit, MI (Dr. Levine)
Department of Pathology, Henry Ford Hospital, Detroit, MI (Dr. Chason)
Department of Neurological Surgery, Henry Ford Hospital, Detroit, MI (Dr. Ausman)
Department of Neurology Denver General Hospital and the University of Colorado School of Medicine, Denver, CO.(Dr. Earnest)
Department of Pathology Denver General Hospital and the University of Colorado School of Medicine, Denver, CO. (Dr. Clark)
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.
Address correspondence and reprint requests to Dr. Pessin, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111.
Received June 3, 1988. Accepted for publication in final form July 8, 1988.
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