Content area
Full Text
Introduction
Basilar artery (BA) hypoplasia is a rare vascular variant with no reliable data regarding its prevalence. It was reported to be associated with a posterior circulation infarct among patients with undetermined or lacunar stroke [1]. Intracranial lipoma is a very rare benign tumor that is believed to constitute less than 0.5% of all intracranial tumors [2, 3]. It is a congenital malformation that is generally accepted to result from an abnormal differentiation of the primitive meninx [4]. Most of these tumors are found to be located at the midline subarachnoid cisterns, most frequently in the pericallosal and quadrigeminal/superior cerebellar regions [4, 5]. 15–55% of the lesions were reportedly associated with other anomalies of the adjacent brain region, including corpus callosum dysplasia, inferior colliculus hypoplasia, vermis hypoplasia, aneurysm, aqueductal stenosis, and mega cisterna magna [3-5].
The presenting case showed transient symptoms of vertebrobasilar insufficiency, which was thus presumably associated with BA hypoplasia. Also, an intracranial lipoma was coincidentally found in the quadrigeminal cistern and the superior vermis. This is the first case report, to our knowledge, of a coincidental vertebrobasilar transient ischemic attack associated with BA hypoplasia and intracranial lipoma.
Case Report
A 52-year-old previously healthy woman presented to the emergency room with sudden-onset anarthria and quadriplegia. During the initial stage of the attack at home, the patient suddenly fell down and felt a sense of being dizzy, then experienced that she could not move any limbs and articulate any words. In the emergency room, the neurologic exam showed severe dysarthria (it was difficult to be intelligible for the patient) and quadriplegia (symmetric weakness of Medical Research Council grade 2 in all limbs). At that time, the patient was alert. Cranial nerve examination was negative, except for a doubtful bilateral facial weakness. Deep tendon reflexes were symmetric and slightly hyperactive in the bilateral limbs, but no Babinski sign was present. The patient’s symptoms completely recovered within 10 min after arrival at the emergency department. In the end, it was noted that total symptom duration was about 30 min. When questioned, the patient denied the occurrence of diplopia, loss of consciousness, abnormal movement, headache, hearing loss, or tinnitus. The patient’s initial blood pressure was 200/120 mm Hg, but the body temperature, pulse, and respiratory rate were...