J Cerebrovasc Endovasc Neurosurg.  2016 Jun;18(2):100-105. 10.7461/jcen.2016.18.2.100.

Acute Pontine Infarction due to Basilar Artery Dissection from Strenuous Physical Effort: One from Sexual Intercourse and Another from Defecation

• Kim SH
• Lee YS
• Suh SJ
• Lee JH
• Ryu KY
• Kang DG

• KMID: 2354883
• DOI: http://doi.org/10.7461/jcen.2016.18.2.100

Abstract

A basilar artery dissection (BAD) is an extremely rare disease. It can lead to hemorrhage or infarction involving the brain stem, and is often associated with grave outcome. However, little is known about the pathophysiology of BAD, and its proper managements are yet in controversy. Herein, we report on two rare cases of basilar artery dissection from strenuous physical effort; one from sexual intercourse and another from defecation. The treatment modalities and the outcomes are also discussed.

Keyword

Basilar artery dissection; Physical effort; Stenting

MeSH Terms

Basilar Artery*
Brain Stem
Coitus*
Defecation*
Hemorrhage
Infarction*
Physical Exertion*
Rare Diseases

Figure

• 

  Fig. 1 Diffusion-weighted MRI shows a pontine infarction. MRI = magnetic resonance imaging.

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  Fig. 2 Antero-posterior (AP) view (A) and lateral view (B) of vertebral angiogram demonstrate an abrupt filling defect at the anterior wall of the mid-basilar artery. AP (C) and lateral (D) views after stenting show completely restored distal flow.

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  Fig. 3 Diffusion-weighted MRI reveals a pontine infarction (A). The hyperintense lesion (white arrow) at the right anterior wall of the basilar artery on T1-weighted MRI indicates mural hematoma (B). MRI = magnetic resonance imaging.

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  Fig. 4 AP view (A) and left anterior oblique view (B) of vertebral angiogram show a contrast filling defect (white arrows) at the right anterior wall of the mid-basilar artery. AP = antero-posterior.

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  Fig. 5 Left anterior oblique view (A) of follow-up vertebral angiogram after two weeks shows a fusiform aneurysmal dilatation of the false lumen. Note that the intimal flap is clearly visualized. Immediate post-procedural angiogram (B) reveals some residual false lumen although it is somewhat collapsed. Follow-up angiogram (C) in a similar projection angle at two months after the initial ischemic onset shows a complete healing of the dissection.

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