Open AccessBilateral pontine infarction with basilar artery fenestration
Author(s) -
Sang Hee Ha,
HyugGi Kim,
Bum Joon Kim
Publication year - 2020
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000021530
Subject(s) - medicine , basilar artery , fenestration , infarction , magnetic resonance imaging , cerebral infarction , stroke (engine) , radiology , surgery , cardiology , ischemia , myocardial infarction , mechanical engineering , engineering
Rationale: Basilar artery (BA) fenestration is a congenital anomaly with duplicated BA, which can cause ischemic stroke. However, the stroke mechanism is not clearly verified in patients with BA fenestration. Patient concerns: Here, we report a case of 64-year-old man with well-controlled hypertension admitted with dysarthria, only. Diagnoses: Diffusion weighted image showed a bilateral symmetric pontine infarction sparing the midline. BA fenestration was observed from magnetic resonance angiography. Intervention: High-resolution magnetic resonance image (MRI) and 4D flow MRI was performed to verify the mechanism of stroke associated with BA fenestration. Outcomes: No plaque was observed at the area of BA fenestration from high-resolution MRI. 4D flow MRI showed bifurcated flow with high flow velocity and low shear stress at the area of BA fenestration. Lessons: A turbulent flow with high flow velocity and low shear stress at the BA fenestration area may have influenced the flow through the bilateral perforating arteries resulting in a bilateral symmetric pontine infarction with sparing the midline where the septa of BA is located. 4D flow dynamic studies may be beneficial for verifying the mechanism of stroke.