Vessel wall MRI for suspected isolated basilar artery dissection

doi:10.1016/j.jocn.2015.11.010

Journal of Clinical Neuroscience

Volume 27, May 2016, Pages 177-179

https://doi.org/10.1016/j.jocn.2015.11.010 Get rights and content

Highlights

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In the reported case, angiography did not elucidate findings definitive of basilar dissection.
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Using our standard vessel wall (VW) MRI protocol, pre- and post-contrast T1- weighted sequence with black-blood sequence, we identified an intimal flap and double lumen and confirmed the diagnosis of dissection.
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Follow up with time-of-flight MR angiography and VW-MRI showed resolution of initial findings, suggestive of luminal healing.

Abstract

Isolated basilar artery dissection is an uncommon intracranial vasculopathy with a poor prognosis. Digital subtraction angiography is considered the definitive modality for diagnosis. Vessel wall MRI (VW-MRI) is an emerging non-invasive technique for assessing the structural integrity of intracranial vessel walls and lumina. Recently, a small number of studies have described the vessel wall patterns of intracranial artery dissection. However, studies on vessel wall imaging of isolated basilar artery dissection remain limited. We describe a patient with suspected isolated spontaneous basilar artery dissection diagnosed using VW-MRI.

Section snippets

Background

Isolated spontaneous basilar artery dissections are an uncommon cause of stroke; with an estimated incidence of 1/400,000 in one study [1]. Clinical manifestations include acute infarction and subarachnoid hemorrhage. Prognosis is poor, with a higher mortality for ruptured versus unruptured basilar artery dissections [1]. Diagnosis and medical management is difficult, and treatment is often empirical anticoagulation. However, endosurgical intervention may be warranted in cases refractory to

Case presentation

A patient in their forties with a history of hypertension presented with sudden unconsciousness preceded by occipital headache, right upper extremity weakness and slurred speech. Physical examination revealed a right facial droop, dysarthria, minimal right upper extremity drift, 4/5 strength, and ataxia on finger-to-nose testing.

A head CT scan showed no evidence of stroke. An MRI of the brain without contrast and time-of-flight (TOF) MR angiography (MRA) revealed three small linear foci of

Discussion

Isolated basilar artery dissection is an extremely rare cause of stroke [1]. We describe a patient with spontaneous isolated distal basilar artery dissection, presenting with acute pontine and cerebellar stroke, diagnosed with VW-MRI after indeterminate findings on DSA post-gadolinium. VW-MRI showed pathognomonic findings of a dual lumen separated by an enhancing intimal flap, wall thickening and eccentric wall enhancement in the region distal to the dissection. DSA is still considered the

Conflicts of Interest/Disclosures

The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

References (6)

M. Reucker et al.
Basilar artery dissection: series of 12 consecutive cases and review of the literature
Cerebrovasc Dis
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E.C. Obusez et al.
High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis
Am J Neuroradiol
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R.H. Swartz et al.
Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI
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There are more references available in the full text version of this article.

Cited by (6)

Feasibility of vessel wall imaging in assessing unruptured paraclinoid aneurysms: Clinical observations and preliminary experience
2019, Journal of Clinical Neuroscience
Citation Excerpt :
The optic strut as an anatomic bony landmark of the dural ring on CTA has also been increasingly advocated but also has its limitations [15,16]. Recently, VW-MRI techniques, [17] have been used to characterize several intracranial pathologies [18–22]. The aim of this study was to investigate the potential utility of VW-MRI, which employs high-resolution 3T post-gadolinium T1-weighted black blood vessel wall imaging, as a feasible tool in distinguishing extradural and intradural paraclinoid aneurysms.
The determination of the precise location of unruptured paraclinoid aneurysms with respect to the dura is essential in order to establish the risk of subarachnoid hemorrhage (SAH). In equivocal cases, current imaging modalities are often limited when trying to distinguish the precise relationship of these aneurysms with respect to the dura. We assessed the utility of vessel wall magnetic resonance (VW-MR) imaging in identifying the definitive location of unruptured paraclinoid aneurysms.
We performed an observational retrospective review using a prospective database of patients undergoing 3T VW-MR of the brain. We included patients that underwent VW-MR gadolinium-enhanced T1-weighted black-blood sequences with fat suppression and saturation band to evaluate unruptured paraclinoid region aneurysms. The dural locations of the aneurysms were first identified on DSA or TOF-MRA and subsequently with VW-MR. The location of aneurysms on VW-MR were then compared qualitatively with the reference standard DSA/TOF-MRA by 2 neurovascular imaging experts.
Fifteen patients with unruptured paraclinoid region aneurysms were imaged with VW-MR. The extradural or intradural locations of the aneurysms were determined in 80% of patients using VW-MR compared to 47% with DSA/MRA.
VW-MRI may be a feasible imaging technique for identifying the extradural or intradural location of unruptured paraclinoid aneurysms and may help guide management. Further larger studies may be warranted.
A Basilar Artery Dissection Mimicking Acute Labyrinthitis in A 15-Year-Old Girl
2023, Korean Journal of Otorhinolaryngology-Head and Neck Surgery
CTA evaluation of basilar septations: An entity better characterized as aberrant basilar fenestrations
2021, American Journal of Neuroradiology
Current uses of intracranial vessel wall imaging for clinical practice: A high-resolution MR technique recently available
2020, Arquivos de Neuro-Psiquiatria
Isolated basilar artery dissection with ischemic stroke: Report of 4 cases
2017, Acta Neurologica Taiwanica
Brain vascular imaging techniques
2017, International Journal of Molecular Sciences

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Case ReportVessel wall MRI for suspected isolated basilar artery dissection

Highlights

Abstract

Section snippets

Background

Case presentation

Discussion

Conflicts of Interest/Disclosures

Basilar artery dissection: series of 12 consecutive cases and review of the literature

Cerebrovasc Dis

High-resolution MRI vessel wall imaging: spatial and temporal patterns of reversible cerebral vasoconstriction syndrome and central nervous system vasculitis

Am J Neuroradiol

Intracranial arterial wall imaging using high-resolution 3-tesla contrast-enhanced MRI

Neurology

Case Report
Vessel wall MRI for suspected isolated basilar artery dissection