Miyaji et al. Journal of Medical Case Reports 2014, 8:395 http://www.jmedicalcasereports.com/content/8/1/395

CASE REPORT

JOURNAL OF MEDICAL

CASE REPORTS Open Access

High-resolution magnetic resonance imaging findings of basilar artery plaque in a patient with branch atheromatous disease: a case report Yosuke Miyaji1*, Yuichi Kawabata1, Hideto Joki1, Shunsuke Seki2, Kentaro Mori2, Tomoya Kamide2, Akira Tamase2, Motohiro Nomura2, Yoshihisa Kitamura2 and Fumiaki Tanaka3

Abstract Introduction: Intracranial branch atheromatous disease is a type of ischemic stroke that is caused by narrowing or occlusion of the orifice of the penetrating artery by atheromatous plaque. Pontine branch atheromatous disease is usually diagnosed using indirect findings such as the extension of a lesion to the basal surface of the pons because of the difficulty of demonstrating plaque in the basilar artery. Case presentation: A 72-year-old Japanese man developed sudden dysarthria and left hemiparesis, and his symptoms deteriorated thereafter. Brain magnetic resonance imaging revealed an acute infarction in the territory of the right paramedian pontine artery extending to the basal surface. Non-contrast-enhanced three-dimensional fast spin-echo T1 imaging with variable flip angles and three-dimensional fast imaging with steady-state acquisition revealed a plaque in the dorsal wall of the basilar artery that spread to the origin of the paramedian pontine artery that branched toward the infarction. Although antithrombotic agents were started, the left hemiparesis got worse and became flaccid on the following day. Conclusions: This is the first report to confirm the pathological basis of branch atheromatous disease by three-dimensional images using the new modalities of 3-Tesla magnetic resonance imaging. The use of these techniques will foster better understanding of the clinicopathological mechanisms of branch atheromatous disease. Keywords: Basilar artery, Branch atheromatous disease, Magnetic resonance imaging, Paramedian pontine artery, Progressive motor deficits

Introduction Intracranial branch atheromatous disease (BAD) is a type of ischemic stroke that is caused by narrowing or occlusion of the orifice of the penetrating artery by atheromatous plaque. Pontine BAD is usually diagnosed using indirect magnetic resonance imaging (MRI) findings such as the extension of a lesion to the basal surface of the pons. Here we report a case of pontine BAD diagnosed directly by the radiographic demonstration of BAD pathophysiology using 3-Tesla MRI.

* Correspondence: [email protected] 1 Department of Neurology and Stroke Medicine, Yokohama Sakae Kyosai Hospital, 132 Katsura-cho, Sakae-ku, Yokohama 247-8581, Japan Full list of author information is available at the end of the article

Case presentation A 72-year-old Japanese man with hypertension, diabetes mellitus, and dyslipidemia presented with sudden left hemiparesis in the early afternoon. He developed dysarthria and choked on food and drink in the evening. By the next morning, the left hemiparesis had progressed and he could not stand up. He was taken by ambulance and admitted to our hospital; on admission a neurological examination revealed dysarthria and left hemiparesis involving his face, arm, and leg. MRI (Discovery MR750w 3.0T, GE Medical Systems, Milwaukee, WI, USA) revealed an acute infarction in the territory of the right paramedian pontine artery (PPA) extending to the basal surface (Figure 1A). MR angiography showed only a slightly irregular wall of the basilar artery. Digital subtraction angiography showed moderate stenosis of less than 50% in the basilar artery

© 2014 Miyaji et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Miyaji et al. Journal of Medical Case Reports 2014, 8:395 http://www.jmedicalcasereports.com/content/8/1/395

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Figure 1 Magnetic resonance imaging. (A) Axial diffusion-weighted image showing an acute infarction in the territory of the right paramedian pontine artery that extends to the basal surface. (B) Sagittal digital subtraction angiography image showing moderate stenosis (

High-resolution magnetic resonance imaging findings of basilar artery plaque in a patient with branch atheromatous disease: a case report.

Intracranial branch atheromatous disease is a type of ischemic stroke that is caused by narrowing or occlusion of the orifice of the penetrating arter...
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