title: High-resolution magnetic resonance imaging findings of basilar artery plaque in a patient with branch atheromatous disease: a case report.
abstract: BACKGROUND
  Intracranial branch atheromatous disease is a type of ischemic stroke that is caused by narrowing or occlusion of the orifice of the penetrating artery by atheromatous plaque. Pontine branch atheromatous disease is usually diagnosed using indirect findings such as the extension of a lesion to the basal surface of the pons because of the difficulty of demonstrating plaque in the basilar artery.
  
  
  METHODS
  A 72-year-old Japanese man developed sudden dysarthria and left hemiparesis, and his symptoms deteriorated thereafter. Brain magnetic resonance imaging revealed an acute infarction in the territory of the right paramedian pontine artery extending to the basal surface. Non-contrast-enhanced three-dimensional fast spin-echo T1 imaging with variable flip angles and three-dimensional fast imaging with steady-state acquisition revealed a plaque in the dorsal wall of the basilar artery that spread to the origin of the paramedian pontine artery that branched toward the infarction. Although antithrombotic agents were started, the left hemiparesis got worse and became flaccid on the following day.
  
  
  CONCLUSIONS
  This is the first report to confirm the pathological basis of branch atheromatous disease by three-dimensional images using the new modalities of 3-Tesla magnetic resonance imaging. The use of these techniques will foster better understanding of the clinicopathological mechanisms of branch atheromatous disease.
authors.affiliation: Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama 247-8581, Japan. mmmyosuke@yahoo.co.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Miyaji
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kawabata
authors.forename: Hideto
authors.initials: H
authors.lastname: Joki
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Seki
authors.forename: Kentaro
authors.initials: K
authors.lastname: Mori
authors.forename: Tomoya
authors.initials: T
authors.lastname: Kamide
authors.forename: Akira
authors.initials: A
authors.lastname: Tamase
authors.forename: Motohiro
authors.initials: M
authors.lastname: Nomura
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Kitamura
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D001488:Basilar Artery / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D059906:Neuroimaging; D058226:Plaque, Atherosclerotic / Q000175:diagnosis* / Q000473:pathology; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis* / Q000473:pathology