Association between an aplastic basilar artery, unaccompanied by a primitive carotid-vertebrobasilar anastomosis, and multiple aneurysms on the dominant posterior communicating artery.
Basilar artery (BA) aplasia when unaccompanied by a primitive carotid-vertebrobasilar anastomosis is exceedingly rare. The association of BA aplasia with two aneurysms on the dominant posterior communicating artery (PCoA) has not been previously reported. This 40-year-old man presented in a state of drowsiness and responded to simple commands only after being coaxed. He had complete left cranial third nerve palsy, right hemiparesis, and persisting signs of meningeal irritation. A computerized tomography (CT) scan revealed subarachnoid and intraventricular hemorrhage. An angiogram revealed BA aplasia. The right PCoA followed a sinuous course with multiple loops and provided the dominant supply to the posterior circulation. This vessel harbored two aneurysms, one at the origin of the PCoA from the internal carotid artery and the other at the looping segment just proximal to the brainstem. The left PCoA was extremely thin. The pterional transsylvian approach was used to clip the two aneurysms on the PCoA. The hemodynamic changes produced by the BA aplasia may have produced alterations in the cerebral vasculature leading to aneurysm formation and consequent subarachnoid hemorrhage.
Behari
Sanjay
S
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
Krishna
Himanshu
H
Kumar
Marakani V Kiran
MV
Sawlani
Vijay
V
Phadke
Rajendra V
RV
Jain
Vijendra K
VK
D000328:Adult; D015901:Angiography, Digital Subtraction; D001488:Basilar Artery / Q000002:abnormalities*; D001921:Brain / Q000098:blood supply; D001925:Brain Damage, Chronic / Q000175:diagnosis; D002339:Carotid Arteries / Q000002:abnormalities* / Q000473:pathology; D002533:Cerebral Angiography; D004292:Dominance, Cerebral / Q000502:physiology*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D002532:Intracranial Aneurysm / Q000151:congenital* / Q000175:diagnosis / Q000601:surgery; D002538:Intracranial Arteriovenous Malformations / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000175:diagnosis; D012086:Reoperation; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000002:abnormalities* / Q000473:pathology