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CT chest-cerebral angiography for basilar artery occlusion caused by pulmonary arteriovenous malformation

Natsumi Nakai1, Toshihisa Ichiba1, Masako Hata1

  • 1Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan.

BMJ Case Reports
|May 2, 2023
PubMed

Early diagnosis of basilar artery occlusion (BAO) based only on clinical findings is challenging. We present a fully recovered case of BAO caused by pulmonary arteriovenous malformation (PAVM) that was diagnosed early using a protocol for CT angiography (CTA) and promptly treated with endovascular therapy (EVT). A woman in her 50s complained of vertigo with normal level of consciousness (LOC). On arrival, her LOC decreased to a Grass Coma Scale score of 12, and we performed a CT chest-cerebral angiography protocol. Head CTA showed BAO, and an intravenous tissue plasminogen activator was administered, followed by EVT. Chest contrast-enhanced CT showed PAVM in segment 10 of the left lung, which was treated with coil embolisation. For patients with a complaint of vertigo, BAO should be suspected, even if they have an initially normal LOC. A CT chest-cerebral angiography protocol is useful for prompt diagnosis and treatment of BAO and can reveal undetermined causes.

Keywords:
Emergency medicineRadiologyStrokeVenous thromboembolism

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