Stroke in patients with fusiform vertebrobasilar aneurysms

Area of Science:

• Neurology
• Vascular Surgery
• Radiology

Background:

• Brainstem infarction is a serious neurological event.
• Large fusiform vertebrobasilar aneurysms are rare but significant vascular abnormalities.
• Understanding the relationship between these aneurysms and stroke is crucial for patient management.

Purpose of the Study:

• To elucidate the clinical, radiologic, and pathologic features of brainstem infarction associated with large fusiform vertebrobasilar aneurysms.
• To identify the mechanisms by which these aneurysms lead to stroke.
• To differentiate clinical presentations and outcomes.

Main Methods:

• Retrospective study of seven patients with brainstem infarction and large fusiform vertebrobasilar aneurysms.
• Review of clinical presentations, neuroimaging (angiography, CT), and pathological findings from autopsy cases.
• Correlation of aneurysm characteristics with stroke patterns and outcomes.

Main Results:

• All patients experienced pontine infarcts; one also had a cerebellar infarct.
• Transient ischemic attacks preceded infarction in four patients.
• Mechanisms included intraluminal thrombi, atherostenosis, and obstruction of penetrating arteries.
• Two distinct clinical patterns emerged: unilateral pontine infarcts (favorable outcome) and bilateral pontine infarcts (fatal).
• Autopsy revealed thrombus, embolism, and one case of aneurysmal rupture with subarachnoid hemorrhage.

Conclusions:

• Fusiform vertebrobasilar aneurysms are a cause of brainstem stroke through intraluminal thrombus, embolism, atherostenosis, and penetrating artery obstruction.
• Clinical presentation varies, impacting prognosis.
• Subarachnoid hemorrhage is an infrequent complication.