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Case Reports: Reminder of important clinical lesson
CT chest-cerebral angiography for basilar artery occlusion caused by pulmonary arteriovenous malformation
  1. Natsumi Nakai,
  2. Toshihisa Ichiba,
  3. Masako Hata and
  4. Yuji Okazaki
  1. Emergency Medicine, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Hiroshima, Japan
  1. Correspondence to Dr Yuji Okazaki; ur8nibhc1{at}gmail.com

Abstract

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.

  • Venous thromboembolism
  • Emergency medicine
  • Stroke
  • Radiology

http://dx.doi.org/10.1136/bcr-2022-253215

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    Footnotes

    • Contributors All authors contributed to the development of this manuscript. NN was writing all manuscript. TI and YO were responsible for literature search. TI, MH and YO were supervisors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.