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Título

SPONTANEOUS DISSECTION OF THE BASILLAR ARTERY: CASE REPORT

RESUMO

Female, 16 years old, history of migraine, without other comorbidities. She presented intense pain in the cephalic region, evolving immediately with loss of consciousness, without previous traumatic brain injury. Therefore, she was admitted to an intensive care unit. Brain computed tomography with contrast performed in the acute phase showed hyperdensity in the basilar artery with filling failure after contrast, suggesting a thrombus inside it, without hemorrhagic transformation. The patient was admitted by neurology after 14 days of ictus presenting tetrasegmental hypotrophy, reduced tone and complete quadriplegia provided. Tetrasegmental hyperreflexia with pyramidal signs. Tromner and Hoffman are present. Plantar cutaneous reflex in extension to the left and indifferent to the right. Absence of meningeal signs. Isophotoreactive pupils. Slowed ocular motricity. Facial mimicry without alterations, paralysis of the conjugated gaze to the left, nausea reflex absent. She underwent cranial magnetic resonance angiography 25 days after the event, showing a caliber reduction of about 50% in the middle third of the basilar artery. During hospitalization, a negative investigation was performed for vasculitis and thrombophilia.
Dissection is the loss of structural integrity of the arterial wall, allowing blood to pool between the arterial layers. Occlusive disease of the basilar artery most often presents as pons ischemia. The paramedian pontine base contains the descending long motor tract and the cerebellar fibers that cross it. The paramedian tegmentum contains mainly oculomotor fibers. Altered level of consciousness is an important sign in patients with basilar artery occlusion. They may present with coma when the bilateral medial pontine tegmentum suffers ischemic insult.
In the case report, a cerebrovascular accident was evidenced after spontaneous dissection of the basilar artery, compromising the brainstem, generating Basilar Artery Syndrome characterized by motor and oculomotor signs and alteration in the level of consciousness.

Palavras Chave

Basilar artery. Basilar artery syndrome. Brainstem.