Rapid fatal thrombosis of giant fusiform basilar artery aneurysm

ABSTRACT

Thrombosed giant fusiform aneurysms are often revealed by progressive ischemic symptoms and are generally treated by anticoagulation therapy with long-term favourable outcome. We report a case of a 73-year-old man with past history of atherosclerotic and cardiovascular diseases, admitted to our hospital with symptoms of acute brainstem transient ischemic attacks. Neuroimaging showed a giant fusiform aneurysm of the basilar artery with recent posterior intra aneurysmatic thrombus. Anticoagulation therapy was initiated, but rapid deterioration occurred resulting in massive stroke and disturbance of consciousness. Computed tomography scan showed complete occlusion of the aneurysm with unilateral brainstem infarct. The patient died rapidly. It appears that anticoagulation therapy, used in the treatment of fusiform aneurysm revealed by ischemic symptoms, is not efficient and will not prevent further ischemic events and fatal outcome in some complex cases