A unique finding of the basilar artery
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ANATOMIC VARIATIONS
A unique finding of the basilar artery Raja Gnanadev1 · Joe Iwanaga2 · Marios Loukas1 · R. Shane Tubbs1,2,4,5 · Christoph J. Griessenauer3 Received: 16 September 2020 / Accepted: 20 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Variants of the posterior intracranial circulation are important for surgeon, interventionalists and radiologists. Herein, a unique configuration of the basilar artery is reported. A 54-year-old man with a history of COPD, hypothyroidism, smoking, and hyperlipidemia presented to an outside institution with nausea, confusion, altered mental status, and ataxia. The patient was evaluated for stroke. Imaging revealed rotation of the basilar apex of 180 degrees, fetal configuration of the posterior communicating artery, right posterior cerebral artery filling from the left vertebral artery, and duplication of the left and right superior cerebellar arteries. The patient continued to deteriorate neurologically and MRI revealed multifocal and symmetric signal abnormalities in the brain stem, thalami, basal ganglia, and hippocampi. The differential diagnosis included acute disseminated myeloencephalitis. Despite plasma exchange and steroid therapy, the patient died a few days later. This case report demonstrates a rare variation of the basilar apex. Keywords Posterior intracranial circulation · Basilar artery · Vertebral artery · Stroke · Anatomy
Introduction The basilar artery is formed by the anastomosis of the vertebral arteries along the anterior midline of the brain stem at the pontomedullary border. Distally, the basilar artery gives rise to pontine branches, the anterior inferior cerebellar arteries, and the superior cerebellar artery. Although typically a branch of the anterior inferior cerebellar artery, the labyrinthine can also originate from the basilar artery [13, 15]. Most often discovered by computed tomography (CT) angiography (CTA) in patients presenting with acute * Joe Iwanaga [email protected] 1
Department of Anatomical Sciences, St. George’s University, St. George’s, Grenada
2
Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, 131 S. Robertson St. Suite 1300, New Orleans, LA 70112, USA
3
Neuroscience Institute, Geisinger Medical Center, Danville, PA, USA
4
Department of Neurosurgery and Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, LA, USA
5
Department of Structural and Cellular Biology, Tulane University School of Medicine, New Orleans, LA, USA
cerebrovascular problems, variants in vertebrobasilar circulation are common [2]. In Riggs and Rupp’s 1963 study on arterial variants of the brain, 79% of specimens studied exhibited variation of the classic anatomy [10]. The most common variants in vertebrobasilar circulation are related to the complexity of the embryology of the intracerebral circulation, particularly at the vertebrobasilar junction [4]. In this case report, we present a patient presenting with stroke-like sy
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