Traumatic basilar artery dissection causing locked-in syndrome

Area of Science:

• Neurology
• Vascular Imaging
• Neuroscience

Background:

• Traumatic arterial dissection is a significant cause of stroke, particularly in younger individuals.
• Basilar artery dissection, though rare, can lead to severe neurological deficits.
• Locked-in syndrome is a devastating condition characterized by complete paralysis with preserved consciousness.

Observation:

• A patient presented with locked-in syndrome following trauma.
• Magnetic resonance imaging (MRI) revealed pontine infarction and a characteristic high-intensity ring in the basilar artery lumen.
• Vertebral angiography demonstrated a double lumen in the basilar artery, confirming dissection.

Findings:

• The combination of MRI and vertebral angiography is essential for diagnosing basilar artery dissection.
• MRI findings, including infarction and luminal abnormalities, are suggestive of dissection.
• Angiography provides definitive visualization of the intimal tear and luminal compromise.

Implications:

• Early and accurate diagnosis of basilar artery dissection is critical for timely intervention and improved patient outcomes.
• Non-invasive imaging like MRI should be considered the initial screening tool due to its lower risk profile.
• Understanding the complementary roles of different imaging modalities can optimize diagnostic pathways for cerebrovascular emergencies.